Partnership Review of Medical Claims Submitted by an Alternate Payee Under The Illinois Medicaid Program - Illinois Department of Public Aid, Springfield, Illinois

The objective of this joint review with the OIG of the Illinois Department of Public Aid (IDPA) was to develop and validate a time dependent billing routine that would identify practitioners who submitted claims for more time than is feasible in a day.  The time dependent billing routine identified practitioners who billed for one or more 12-hour days for dates of service from July 1, 1998 to June 30, 2000, inclusive.  These physicians had charged for more time than is feasible in a day.  We recommended that IDPA instruct physicians to submit properly coded claims based on the level of care and time spent by the physician with each patient.  The IDPA concurred with our findings and recommendation.