Medicare Advantage organizations can do more to curb improper billing, inspector general says

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To protect against improper billing and ordering, Medicare Advantage organizations can improve the use of national provider identifiers for providers who order or refer high-risk services for beneficiaries, according to an April brief from the HHS Office of Inspector General. 

In a report, the office found that nearly half of Medicare Advantage organizations lack ordering national provider identifiers on at least some records. In addition, of those that do collect ordering national provider identifiers, 20 percent do not perform program integrity oversight using these identifiers. 

"These findings indicate that there are unrealized opportunities for MAOs to use ordering NPIs to protect the MA program against fraud and abuse," the office wrote. 

Based on the new evaluation, the office recommended that CMS encourage Medicare Advantage organizations to perform integrity oversight using national provider identifiers.

Access the full brief here.


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