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Ophthalmology clinic to repay CMS $398K after billing errors discovered

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A California-based ophthalmology clinic said it plans to refund CMS more than $398,000 after an HHS investigation found inappropriate billing led to overpayment.

The Office of Inspector General reported in March that the clinic often complied with CMS rules for intravitreal injections of Eylea and Lucentis, but did not always meet requirements when billing for other services on the same day, such as anesthesia injections. Out of 627 services and drugs provided in a 100-day period in 2018, 301 did not meet requirements.

The clinic did not separately bill for 195 services, and 106 services and drugs were deemed not reasonable and necessary, according to the inspector general's report.

The clinic didn't have appropriate policies and procedures for accurate service and drug billing because its medical director was unaware of Medicare requirements, the report states. The clinic agreed to refund Medicare $398,625 in overpayments and implement new policies, according to the report.


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