October 29, 2009

We understand that a number of U.S. Department of Justice ("DOJ") offices are currently sending Contact Letters to hospitals across the country related to alleged inaccurate billing and Medicare overpayments for outpatient infusion therapy and blood transfusions performed between 2003 and the present.  The Contact Letters suggest that the infusion billing inquiry has two issues.  With the first infusion issue, the DOJ alleges that hospitals submitted separate, unbundled HCPCS or CPT codes to Medicare for infusions that were integral parts of another outpatient procedure, which should have been paid solely under the APC for the primary procedure.  With the second infusion issue, the DOJ alleges that hospitals submitted two or more units of infusion HCPCS or CPT codes for the same visit when only one such code was payable per outpatient visit.  The blood transfusion issue similarly involves the alleged submission of multiple units of CPT codes for blood transfusion services more than the once per day per patient that are payable under Medicare regulations.

In many cases, the DOJ is providing hospitals with a list of claims pertaining to the above infusion therapy and blood transfusion issues and requesting that hospitals promptly review the claims in light of applicable CMS guidance.  Hospitals should also review at the same time their files for any past voluntary refunds made for these types of claims. 

If your hospital billed for outpatient infusion therapy and blood transfusions in the past, be advised that you could receive a similar Contact Letter in the near future.  We are currently working with a number of hospitals regarding this national investigation, and if you have any questions or would like assistance in responding, please contact your regular Hall Render attorney, Scott W. Taebel or Katherine A. Kuchan via e-mail at staebel@hallrender.com and kkuchan@hallrender.com or by telephone at (414)721-0442 at Hall, Render, Killian, Heath & Lyman, PC.