OIG finds almost $100 million inappropriately paid for podiatry services - Updata - Department of Health and Human Services Office of Inspector General - Brief Article - Statistical Data Included

Healthcare Financial Management, August, 2002

A recent inspection report from the HHS Office of Inspector General (OIG) has determined that Medicare inappropriately paid about $97 million for nail debridement and related podiatry services during calendar year 2000. Nail debridement involves the removal of a diseased toenail bed or viable nail plate; these services accounted for almost one-fourth ($233 million of $1 billion) of all Medicare payments to podiatrists in 2000.

About $51 million of the inappropriate payments can be attributed to claims without adequate medical justification to support payment. Furthermore, more than half of the inappropriately paid nail debridement claims contained related podiatry services, payment for which would also then be deemed inappropriate. Payment for the related services totaled almost $46 million.

The OIG recommended that CMS require its carriers to closely scrutinize payment for nail debridement services through medical reviews, especially for appropriate documentation. The OIG also encouraged CMS to collect the overpayments found in its sample. CMS concurred with the OIG recommendations.

To read the report, go to http://oig.hhs.gov/oei/reports/oei-04-99-00460.pdf.>

COPYRIGHT 2002 Healthcare Financial Management Association

COPYRIGHT 2002 Gale Group