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Reports (OEI-05-09-00560) and (OEI-05-09-00561)

08-29-2011
Miami Independent Diagnostic Testing Facilities' Compliance with Medicare Standards

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08-29-2011
Los Angeles Independent Diagnostic Testing Facilities' Compliance with Medicare Standards

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Summary

We found that independent diagnostic testing facilities (IDTF) in both the Los Angeles and Miami areas did not comply with Medicare standards that require IDTFs to maintain a physical facility at the location on file with CMS and to be open during business hours. IDTFs that do not comply with Medicare standards are subject to a variety of administrative actions, including revocation of their Medicare billing privileges.

IDTFs, a type of Medicare provider, offer diagnostic services and are independent of a physician's office or hospital. Medicare allowed almost $1 billion for IDTF claims for 2.4 million beneficiaries in 2010. Of this, $62 million was for claims by IDTFs in the Los Angeles and Miami areas.

IDTF services have historically been vulnerable to abuse. In site visits in 1997, OIG found that 20 percent of IDTFs were not at the locations on file with CMS. A 2001 OIG review of IDTF claims projected $71.5 million in improper Medicare payments for these services.

Miami

We performed unannounced site visits in May 2010 and found that 27 of the 92 Miami-area IDTFs failed to comply with selected Medicare standards. As a result of a special enrollment project and routine oversight, CMS took action against 23 of the 27 noncompliant IDTFs that our report identified. However, three IDTFs continued to receive Medicare payments while CMS was revoking their billing privileges.

We recommended that CMS (1) periodically conduct unannounced site visits to IDTFs and (2) immediately stop payments to IDTFs whose billing privileges are being revoked. CMS concurred with our recommendations. We did not recommend a moratorium in Miami due to the existence of the special enrollment project that screens new enrollees.

Los Angeles

We performed unannounced site visits in May and June 2010 and found that 46 of the 132 Los Angeles-area IDTFs failed to comply with selected Medicare standards. Of the 46 noncompliant IDTFs, 25 submitted claims representing services performed on the same dates that site reviewers visited their locations.

We recommended that CMS (1) periodically conduct unannounced site visits to IDTFs, (2) take action against the noncompliant IDTFs identified by our site visits, and (3) impose a moratorium on the enrollment of IDTFs in the Los Angeles area. CMS concurred with our first two recommendations. CMS did not concur with our recommendation to impose a moratorium but stated that it would take the recommendation under strong consideration.

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