Medicare improperly paid an estimated $15.2 million for sacroiliac joint injection sessions that did not meet Medicare requirements between Oct. 1, 2023, and Sept. 30, 2024, according to an Aug. 5 report from HHS’ Office of Inspector General.
The OIG reviewed a sample of 100 sacroiliac joint injection sessions and found that 72 did not comply with Medicare requirements. Physicians’ billing for 25 of the sampled sessions also did not meet Medicare guidance. Based on those findings, the agency estimated Medicare improperly paid for 134,526 of 186,842 total sessions during the audit period. It also estimated physicians incorrectly billed 46,711 sessions as therapeutic injections instead of diagnostic injections.
The audit found CMS and Medicare administrative contractors did not provide sufficient oversight to ensure compliance with Medicare requirements and guidance for the procedures.
The OIG recommended CMS work with Medicare administrative contractors to develop provider education on Medicare requirements and billing guidance for sacroiliac joint injections, and implement solutions to prevent diagnostic injections from being incorrectly billed as therapeutic injections. CMS concurred with the first two recommendations but did not concur with the third, according to the report.
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