IMRT + OIG

[scarbrtj]

The OIG's morbid fascination with IMRT continues. To paraphrase the old saying "How do you know when a lawyer is lying? His mouth is moving"... How do you know when a radiation oncology dept. is committing fraud? It's billing for IMRT. (In this "random sample" by the OIG, 98% of departments inappropriately billed/coded and received payment for services associated with IMRT.)

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[Chartreuse Wombat]

The OIG's morbid fascination with IMRT continues. To paraphrase the old saying "How do you know when a lawyer is lying? His mouth is moving"... How do you know when a radiation oncology dept. is committing fraud? It's billing for IMRT. (In this "random sample" by the OIG, 98% of departments inappropriately billed/coded and received payment for services associated with IMRT.)

Same reason that Sutton robbed banks. Small specialty (limited political impact; sorry ASTROPAC) with one of the largest increases in Medicare billing. Easy target and lots of government attorneys need to make a career.

 

[OTN]

The OIG's morbid fascination with IMRT continues. To paraphrase the old saying "How do you know when a lawyer is lying? His mouth is moving"... How do you know when a radiation oncology dept. is committing fraud? It's billing for IMRT. (In this "random sample" by the OIG, 98% of departments inappropriately billed/coded and received payment for services associated with IMRT.)

The fact that 98% of departments couldn't get it right suggests very strongly the problem lies in the system itself. Once you criminalize the basic practice of medicine by making it very, very difficult to get it right 100% of the time, well not a surprise you find "fraud" whenever you look for it.

 

[evilbooyaa]

The fact that 98% of departments couldn't get it right suggests very strongly the problem lies in the system itself. Once you criminalize the basic practice of medicine by making it very, very difficult to get it right 100% of the time, well not a surprise you find "fraud" whenever you look for it.

The vast majority of IMRT billing was correct. They estimate that 103.4 million was paid out, 7.2 million of which was 'overpayment', which is less than 7% of the total amount paid over their trial period. The 98% of facilities nonsense is the clickbait that gets you to open the link. Glad to see even OIG is going to buzzfeed like clickbait titles.

And of course it's the system. They're basically saying that billing CPT code 77301 (and related codes) along with a code for IMRT planning isn't allowed.
To have 4 places where IMRT was post-hoc deemed medically unnecessary is nonsense, IMO.