The U.S. Department of Health and Human Services Office of the Inspector General (OIG) recently informed the university that it intends to audit Medicare Part B billings by USC physicians. The audit would examine adherence to Medicare rules governing payment for physician services provided in a teaching setting, and ensure claims submitted in previous years reflect actual levels of service to patients.
The audit, known as Physicians at Teaching Hospitals (PATH) initiative, is a nationwide effort started in June 1996. Under the initiative, the OIG is now auditing 33 academic medical centers. Two teaching hospitals have reached settlements with the OIG of $30 million and $12 million, after audits determined overpayment by Medicare to teaching physicians.
More recently, the OIG has terminated 16 scheduled audits on the grounds that those academic medical centers received unclear instructions on billing requirements from their Medicare billing carrier.
USC must now determine whether its physicians should challenge the audit based on unclear instructions received from their carrier, Transamerica Occidental Life.
All activities and communication regarding the PATH audit are being coordinated through Jeffry Huffman, CEO and president of USC Care Medical Group, Inc. and corporate compliance officer for USC Care. For more information contact Laura LaCorte, Office of the General Counsel, at 740-7922, or Tammy Capretta, COO and compliance representative for USC Care, at 342-5968.