Issues Under Review

Note: Issues for Part B providers that are approved for audits in the District of Columbia (“DC”) apply to the DC metro area, including the counties of Arlington and Fairfax in Virginia and the city of Alexandria in Virginia.

Issue NumberIssue NameType of ReviewProvider TypeDescending OrderState(s) ImpactedDate PostedDetails
A000452013Postpayment Review - Manual Medical Review of Outpatient Therapy Claims Above the $3,700 ThresholdComplexSkilled Nursing Facility (Part B Only)CT, DC, DE, MA, MD, ME, NH, NJ, RI, VT, PA, NY4/22/2013 Details
A000602012SNF Psychiatric ConditionComplexSkilled Nursing FacilityCT, DC, DE, MD, ME, MA, NH, NJ, NY, PA, RI, VT1/18/2013 Details
A000512012CT Scans, Head and Neck, Incorrect BillingAutomatedSkilled Nursing Facility NY4/2/2012 Details
A000672012CT Scans, Trunk and Extremities, Incorrect BillingAutomated Skilled Nursing FacilityNY4/2/2012 Details
A000812012Vitamin D Assay TestingAutomatedSkilled Nursing FacilityCT, DC, MA, MD, ME, NH, NJ, NY, PA, RI, VT6/4/2012 Details
A000482013Postpayment Review - Manual Medical Review of Outpatient Therapy Claims Above the $3,700 ThresholdComplexRehabilitation Agency (Comprehensive Outpatient Rehabilitation Facility)CT, DC, DE, MA, MD, ME, NH, NJ, RI, VT, NY, PA4/22/2013 Details
A000972013Portable X-ray Transportation and Setup Billed Without a Radiology Code - JKAutomatedPortable X-ray Supplier CT, MA, ME, NH, NY, RI, VT11/22/2013 Details
A000202015Bariatric Surgery - Region AComplexPhysician/Non-physician PractitionerCT, DC, DE, MA, MD, ME, NH, NJ, NY, PA, RI, VT8/11/2015 Details
A000182015Cataract Surgery Once in a Lifetime – JKAutomatedPhysician/Non-physician PractitionerCT, MA, ME, NH, NY, RI & VT8/13/2015 Details
A000262015Observation Care for Fewer Than 8 Hours - JLAutomatedPhysician/Non-physician PractitionerDC, DE, MD, NJ, PA9/3/2015 Details
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