OIG says Medicare improperly paid $66 million for specimen validity billed with urine drug tests

Upon reviewing a sample of Medicare Part B payments for specimen validity testing billed in combination with urine drug testing, the Office of Inspector General (OIG) found that Medicare improperly paid physician offices and clinical laboratories $66.3 million for these services.    

The OIG analyzed individual claim lines submitted between 2014 and 2016 for specimen validity tests paid with urine drug tests for individual beneficiaries on single dates of service. The review covered Medicare payments totaling $67 million.

If a claim line for a specimen validity test included a diagnosis code that indicated the test might have been medically necessary, the claim line was removed from the review, the report said. After removing such claim lines, the OIG arrived at a population of claims with Medicare payments totaling $66.3 million.

To prevent improper payments for specimen validity tests, the OIG recommended that CMS strengthen its system edits. The OIG also recommended that CMS direct Medicare contractors to recover the $66.3 million in identified improper payments. Additionally, the OIG recommended that CMS instruct Medicare contractors to educate providers on proper billing for specimen validity and urine drug tests.

CMS concurred with the OIG’s recommendations and stated that a medical review would be necessary to determine whether the claims were paid properly.

CMS released an MLN Matters Special Edition article on March 29 on how to properly bill for specimen validity testing performed in conjunction with drug testing.