OIG Uncovers ‘Widespread’ Double Billing in Medicare
HHS' Office of the Inspector General found that doctors submitting two bills to Medicare for the same service "regularly get paid twice," a "widespread" problem that could cost the government "substantial sums," the AP/Lexington Herald-Leader reports. According to the OIG report, doctors often submit the same bill to two different insurance companies responsible for processing Medicare claims, resulting in double payments. Although central Medicare facilities "are supposed to check for duplication and errors" and provide a "front-line defense against paying inappropriate claims," the AP/Herald-Leader reports the system "does not appear to be working." OIG studied a sample of 242 double bills from 1998 for 121 services from 86 doctors and found that "none of the double bills was justifiable." In addition, the report found that 25% of the doctors had submitted potential double bills for 20 services, while "a few" submitted them for more than 100 services. OIG estimated that double billing for 15 services that are "not likely to generate two bills in one day for the same person" alone cost Medicare $446,000 in 1998, and "thousands of other procedures ... might be even more vulnerable" to double billing. OIG said, "We believe our findings highlight a significant vulnerability in Medicare's claims processing system." Only eight of the 86 doctors reported that they refunded the "extra money" they had received from Medicare, and seven "did so only after the inspector general asked about it." Asked to "explain themselves," some doctors said they "didn't know how the double bills had occurred," while others "blamed confusion about the proper insurance company and mistakes by billing services" (Meckler, AP/Lexington Herald-Leader, 3/23).