The audit, published June 21, found $888.2 million in potential overpayments for genetic testing generally not needed in the Medicare population.
Auditors examined Medicare payments for CPT code 81408, which indicates genetic testing for rare diseases that appear in childhood, meaning these tests are typically not performed in Medicare-eligible adults. The OIG’s audit found that Medicare did not properly investigate whether these codes were properly billed.
Medicare stopped reimbursing for the code by the end of 2021, according to the OIG. The audit recommended CMS investigate the claims from the audit period to determine if they were properly billed and recover up to $888.2 million in overpayments.
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