Audit of Medicare Part B Payments to a Southern California Podiatrist for the Period June 1, 1992 through

l OFFICE OF INSPECTOR GENERAL AUDIT OF MEDICAR E PART B PAYMENTS TO A SOUTHERN CALIFORNIA PODIATRIS T FOR THE PERIOD JUNE 1, 1992 THROUGH MAY 31, 199 7 JUNE GIBBS BROWN Inspector Genera i This report contains the results of our audit of Medicare Part B payments made by Provider, a podiatrist located in southern California. care. The objective of our review was to determine whether Medicare’s Part B were appropriate. We found that the Medical Provider was overpaid for services completely unallowable or partially unallowable for Medicare reimbursement. The 151 documentation did not support the claimed services or which were Seven of the E&M services were for comprehensive nursing facility establishing the patient’s plan of care. patients’ attending physician; 60 procedural services which were not medically necessary, were not documented, or were and 4 E&M services for which the Medical Provider could not provide any supporting medical records. Services claimed using codes with higher reimbursement rates than was justified by the supporting medical records. The Medical Provider was not the assessment codes which are to be used by the admitting or attending physician in 87 evaluation and management (E&M) services for which the medical record overpayments consisted of: Our review determined that 15 1 services, or 90 percent, of the 167 services were either The 100 claims in our sample included payments for a total of 167 separate services. ...