California Statewide Audit of Inpatient Hemodialysis Procedure Services

This audit report presents the results of our review of inpatient hemodialysis procedure services provided to Medicare beneficiaries residing in the state of California.  Based on a statistical sample of Medicare claims, we are 95 percent confident that at least $3,541,886 of the $22,214,841 paid to physicians for Calendar Years 1998 and 1999 was ineligible for Medicare reimbursement.  We recommended that the Centers for Medicare & Medicaid Services (CMS) develop an education and monitoring program to reinforce the billing requirements for hemodialysis procedures.  We also recommended  that CMS determine if separate reviews for individual physicians or medical group are cost effective, and, if so, perform additional reviews to recover the projected overpayments.