Empire Medicare Services: Audit of Medicare Claims by Podiatrists and Optometrists for Comprehensive Nursing Facility Assessments for Calendar Years 1995 through 1998

EXECUTIVE SUMMARY:

This final audit report presents the results of our audit of claims by podiatrists and optometrists for comprehensive nursing facility (CNF) assessments during Calendar Years 1995 through 1998. We found that podiatrists and optometrists were not licensed to perform CNF assessments. Nonetheless, podiatrists and optometrists submitted claims for these services totaling $4,821,810 and $517,461, respectively. Empire paid $2,905,205 and $320,896 for their claims. We recommended that Empire: (1) issue a reminder to podiatrists and optometrists not to bill for any service outside of the scope of their medical licenses, such as CNF assessments, and (2) implement computer edits to prevent payment of CNF assessments claimed by podiatrists and optometrists. Empire representatives agreed with our audit findings and recommendations, and have implemented the recommended corrective actions. We have requested that Empire not seek recovery of the overpayments at this time as we are still evaluating the issue.