Status Report--Office of Inspector General/Department of Justice Joint Project - Review of Medicare Part B Billings by Physician Group Practices at Teaching Hospitals

EXECUTIVE SUMMARY:

This nationwide project involves a review of Medicare Part B billings by physician group practices at teaching hospitals and is being conducted jointly by the OIG and the Department of Justice (DOJ). At the Clinical Practices of the University of Pennsylvania (CPUP) the joint team found that for a significant number of Medicare Part B bills there was no documentation in the medical records showing that a CPUP physician was present when a resident performed a medical service. Without such documentation, these bills were ineligible for Medicare reimbursement. In other cases bills were upcoded, billed for a more complex level of care than that which was provided, which resulted in increased Medicare reimbursement. As a result of these findings CPUP agreed, in a settlement agreement, to pay over $30 million to the Federal Government for the improper claims submitted during the period January 1, 1989 through December 31, 1994. The settlement agreement also requires CPUP to develop and implement a corrective action plan to address the two major problems identified in our audit.