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Medicare Improperly Paid Physicians an Estimated $30 Million for Spinal Facet-Joint Interventions


March 22, 2023

The Office of Inspector General for the United States Department of Health and Human Services has conducted yet another audit on facet joint interventions, this is the third audit.
There have been extensive audits from UPICs, SMRC, Nordian, and RAC, and MAC contractors.

In this study (click here to read), OIG looked at 120 sample sessions, with only 54 complying with Medicare requirements.
The overall estimated overpayments appear to be $29.6 million for facet joint interventions for an audit period of August 1 through October 31, 2021, with new LCDs in effect.

Obviously, there will be even more audits and there will be recoupment from multiple providers on these claims.

It is crucial that we follow appropriate algorithmic approach and utilize checklists to avoid such issues.


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