Healthcare News: OIG audit targets excessive billing for genetic testing

January 11th, 2022

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Note:  The following article synopsis was NOT provided by HCPro. It was created by Find-A-Code/innoviHealth.

Article Overview

This article covers an Office of Inspector General review of Medicare Part B genetic testing payments and the broader trend of rapidly increasing spending from 2016 through 2019. It is relevant to coders, compliance staff, laboratory billing teams, and auditors who monitor genetic testing claims, fraud risk, and government enforcement activity. The piece also points readers to the broader set of genetic testing services and the CPT coding areas highlighted in the report, along with the OIG’s ongoing fraud-focused oversight efforts.

Why This Topic Matters

It helps healthcare billing and compliance professionals understand why genetic testing claims have drawn federal scrutiny and which general service categories were included in the OIG’s payment review.

What You Will Learn

  • How Medicare genetic testing spending changed over the review period
  • What type of federal review was conducted by the OIG
  • Which broad genetic testing service categories were highlighted in the report
  • Why genetic testing billing is an area of compliance and fraud concern
  • How the article situates the report within ongoing OIG enforcement activity

Who Should Read This

  • Medical coders
  • Compliance officers
  • Laboratory billing staff
  • Revenue cycle teams
  • Healthcare auditors
  • Practice administrators

Codes Discussed

  • CPT: 81528
  • CPT: 81408
  • CPT: 81519
  • CPT: 81162
  • CPT: 81490

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