On October 13, the Office of the Inspector General (OIG) released a new report detailing a recent audit of spinal facet joint injections.
The described goal of this audit was to identify injection sessions exceeding the Medicare coverage limitation, which, in most Medicare jurisdictions, is a maximum of five sessions during a rolling 12-month period. The audit was conducted on claims from 2017-2019 and a total of $748,555 in improper payments was identified. The Centers for Medicare & Medicaid Services (CMS) agreed with the OIG’s recommendation to recover these funds. CMS also agreed to explore strategies for improved oversight and claims review to decrease improper payments for injections in excess of the approved maximum five session.
However, CMS also noted in its response to this audit, that the improper payments represent less than 0.1% of the overall payments made under the Medicare Physician Fee Schedule during the time of the audit. Further, CMS noted that a large portion of the improper payments were made due to an issue with the existing Fraud Prevention System, which has since been corrected.