The Office of the Inspector General (OIG) singled out payments for polysomnography and sleep testing in its fiscal year 2011 Work Plan.
The Work Plan states that the OIG will review the appropriateness of Medicare payments for sleep studies, examine provider compliance with federal program requirements, and look into the factors contributing to the rise in Medicare payments. According to the Work Plan, Medicare payments for polysomnography increased from $62 million in 2001 to $235 million in 2009.
The OIG will also be reviewing the appropriateness of Medicare payments for sleep test procedures offered at sleep labs. “A preliminary OIG review identified improper payments when certain modifiers are not reported with sleep test procedures,” the Work Plan states. As a result, the OIG will examine Medicare payments to physicians and independent diagnostic testing facilities for sleep test procedures to determine whether they were in accordance with Medicare requirements.
The OIG will carry out its review by conducting audits, evaluations, and investigations; providing guidance to industry; and, when appropriate, imposing civil monetary penalties, assessments, and administrative sanctions.