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Fraud, Abuse, Or Retaliation
Where To Report Waste Fraud, Abuse, Or Retaliation

Noridian Healthcare Solutions, LLC, Made $8.8 Million in Improper Capitation Payments to Physicians and Qualified Nonphysician Practitioners in Jurisdiction E for Certain Services Related to End-Stage Renal Disease

Submitting OIG: 
Department of Health & Human Services OIG
Date Issued: 
Tuesday, June 27, 2023
Agency Reviewed / Investigated: 
Department of Health & Human Services
Submitting OIG-Specific Report Number: 
A-09-21-03016
Component, if applicable: 
Centers for Medicare & Medicaid Services
Centers for Medicare and Medicaid Services
External entity, if applicable: 
Noridian Healthcare Solutions, LLC
Location(s): 
United States
Type of Report: 
Audit
Questioned Costs: 
$4,663
Funds for Better Use: 
$8,844,899
Number of Recommendations: 
4
Report updated under NDAA 5274: 
No
View Document: 
AttachmentSize
PDF icon 92103016.pdf2.12 MB

Related Open Recommendations

Recommendation Number Recommendation Status Significant Recommendation Additional Details
23-A-09-086.01 Open No
We recommend that Noridian Healthcare Solutions, LLC recover $4,663 in improper payments made to physicians and qualified nonphysician practitioners for the 26 sampled enrollee-months.
23-A-09-086.02 Open No
We recommend that Noridian Healthcare Solutions, LLC notify the physicians and qualified nonphysician practitioners to refund $1,162 in coinsurance that was collected for the 26 sampled enrollee-months.
23-A-09-086.03 Open No
We recommend that Noridian Healthcare Solutions, LLC based on the results of this audit, notify appropriate physicians and qualified nonphysician practitioners (i.e., those for whom Noridian determines this audit constitutes credible information of potential overpayments) so that the physicians and practitioners 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.
23-A-09-086.04 Open No
We recommend that Noridian Healthcare Solutions, LLC update the educational material on its website as well as any previously provided webinars to include all Medicare requirements and guidance for billing and documenting ESRD-related services and continue to perform medical record reviews as part of the TPE program, which could have saved the Medicare program an estimated $8,844,899 and could have saved Medicare enrollees up to an estimated $2,204,799 for our audit period.
Displaying 4 of 4 Recommendations