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New OIG Report Recommends Medicare Contractors Recover More Than $66M in Improper Payments

First few Article Sentences

The Office of Inspector General (OIG) recently issued a report entitled “Medicare Improperly Paid Providers for Specimen Validity Tests Billed in Combination with Urine Drug Tests.” In this report, the OIG found that payments made to providers for specimen validity testing did not comply with Medicare billing requirements. The OIG found that Centers for Medicare and Medicaid Service (CMS) paid clinical laboratories and physician offices $66.3 million dollars for specimen validity testing billed in conjunction with urine drug tests. It concluded that these payments were made because the providers did not follow existing Medicare guidance.

Specimen validity testing can be medically necessary if used to diagnose certain conditions such as urinary tract infections or kidney stones. However, if the test is used to determine if a specimen is adulterated then the test results “are not being used to manage a beneficiary’s specific medical problem” and are not a separately billable service covered by Medicare.

Cooper, Esq., Richard S.


McDonald Hopkins LLC

Law, Provider Reimbursement

March 6, 2018

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