OIG to Review Radiology Payments and Appropriateness

The U.S. Department of Health and Human Services Office of Inspector General (OIG) will open new studies regarding Medicare Part B imaging payments and appropriateness of many emergency department scans, according to the recently released OIG Fiscal Year 2010 Work Plan. The Work Plan is the OIG's annual "playbook" of upcoming investigations, audits, and reports. Its Work Plan lists health care arrangements it believes cost too many dollars or could violate federal fraud and abuse laws.
 
OIG plans to examine the practice expense components of selected imaging services, including the controversial equipment utilization rate. The Radiology Business Management Association recently published a study confirming that the actual equipment utilization rate nationwide is only 54%—well below the 75% assumption called for in the U.S. House of Representatives’ health care reform legislation.
 
Additionally, OIG will continue its anticipated review of whether Medicare payments for emergency department x-rays and interpretations are appropriate. Other notable projects include an ongoing examination of services and billing patterns in locations with a high density of independent diagnostic testing facilities. OIG also will start inspecting the degree to which data and safety monitoring boards assess safety data in clinical trials.
 
— Source: American College of Radiology