California Lab, Owner Excluded 5 Years for Medicare Screening Test Billings
Case: Billing Medicare for screening exams is illegal. The latest providers to learn that lesson the hard way is Orange, California, independent diagnostic testing facility CHJ Diagnostics, which along with its owner, agreed to a five-year exclusion after OIG investigators discovered it submitted claims for nerve conduction studies considered to be screening exams under Medicare coverage rules. Significance: Although it is not clear exactly what tests were involved, lab billing for Nuclear Stress Tests has become a more frequent target of federal investigators over the past two years. For more details, see “Using Nuclear Stress Tests as Screening Procedure = Medical Necessity Violation,” (NIR, Dec. 12, 2017).
Case: Billing Medicare for screening exams is illegal. The latest providers to learn that lesson the hard way is Orange, California, independent diagnostic testing facility CHJ Diagnostics, which along with its owner, agreed to a five-year exclusion after OIG investigators discovered it submitted claims for nerve conduction studies considered to be screening exams under Medicare coverage rules.
Significance: Although it is not clear exactly what tests were involved, lab billing for Nuclear Stress Tests has become a more frequent target of federal investigators over the past two years. For more details, see “Using Nuclear Stress Tests as Screening Procedure = Medical Necessity Violation,” (NIR, Dec. 12, 2017).
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