Where To Report Waste

Fraud, Abuse, Or Retaliation

CMS's Oversight of Medicare Payments for the Highest Paid Molecular Pathology Genetic Test Was Not Adequate To Reduce the Risk of up to $888 Million in Improper Payments

Submitting OIG:

Department of Health & Human Services OIG

Date Issued:

Wednesday, June 21, 2023

Agency Reviewed / Investigated:

Department of Health & Human Services

Submitting OIG-Specific Report Number:

A-09-22-03010

Component, if applicable:

Centers for Medicare & Medicaid Services

Location(s):

United States

Type of Report:

Audit

Questioned Costs:

$888,169,038

Funds for Better Use:

$0

Report updated under NDAA 5274:

No

View Document:

Attachment	Size
92203010.pdf	1.02 MB

Related Open Recommendations

Recommendation Number	Recommendation Status	Significant Recommendation	Additional Details
23-A-09-085.01	Open	No
We recommend that the Centers for Medicare & Medicaid Services direct the appropriate Medicare contractors to review claims billed under CPT code 81408 for our audit period to determine whether they complied with Medicare requirements.
23-A-09-085.02	Open	No
We recommend that the Centers for Medicare & Medicaid Services direct the appropriate Medicare contractors to determine the amount of improper payments for the claims that did not comply with Medicare requirements and, for those that are within the 4-year claim-reopening period, in accordance with CMS's policies and procedures, recover up to $888,169,038 for claims that were at risk of improper payment during our audit period.
23-A-09-085.03	Open	No
We recommend that the Centers for Medicare & Medicaid Services direct the appropriate Medicare contractors to based upon the results of this audit, notify appropriate providers (i.e., those for whom CMS determines this audit constitutes credible information of potential overpayments) so that the providers can exercise reasonable diligence to identify, report, and return any overpayments in accordance with the 60-day rule and identify any of those returned overpayments as having been made in accordance with this recommendation.