tci Part B Insider - 2015 Issue 35

Compliance: Ophthalmology Providers in WV, NJ Logged High Error Rates

OIG report shines spotlight on questionable billing for wet AMD, cataract surgery. Most practices are aware of the fact that the OIG looks for questionable billing trends, and the agency’s recent review of ophthalmology services was no different—in fact, the OIG even drilled down to look for geographic trends, and found that providers in West Virginia and New Jersey had the highest error rates. Background: The OIG evaluated whether ophthalmology services are vulnerable to fraud, waste and abuse after noting that ophthalmologists collected $6.7 billion for wet age-related macular degeneration (wet AMD) and cataracts in 2012...

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