OIG Finds Inappropriate Medicare Payments for Transforaminal Epidural Injection Services

A recent report issued by the Office of Inspector General (OIG) found that Medicare Part B physician payments for transforaminal epidural injections increased nearly 150% from $57 million in 2003 to $141 million in 2007.  Further, according to the OIG, 35% of transforaminal injection services allowed by Medicare in 2007 did not meet Medicare requirements, resulting in approximately $45 million in improper payments.  An additional $23 million in associated facility claims was allowed by Medicare.  Finally, OIG found that services provided in offices were more likely to have a documentation error than those provided in ASCs or hospital outpatient departments.

Based on the review, OIG recommends that CMS conduct provider education, directly and through contractors, about proper documentation and strengthen program safeguards to prevent improper payment for transforaminal epidural injection services.  In addition, OIG recommends that CMS take appropriate action regarding the undocumented, medically unnecessary, and miscoded services identified in the sample.