MPI investigates possible fraud in EEG services

Medicaid Program Integrity opened six cases based on the identification of providers potentially inappropriately billing for certain electroencephalographic (EEG) services.

Neurologists and other clinicians are billing for an EEG service that requires observation by a clinician who can intervene in the monitoring and/or patient care as needed. An EEG is a test that detects electrical brain activity through small, metal electrodes attached to the scalp.

The OIG initiative focused on two service codes to identify providers who are equipping patients with mobile EEG units and sending them home for overnight monitoring without the presence of a clinician who can intervene. As a result, the providers may have inappropriately received a higher reimbursement amount.

MPI is also analyzing results from a separate fraud detection operation (FDO) focused on claims billed and paid for EEG testing. An FDO is a data-driven investigative operation designed to review providers who appear as statistical outliers among their peers and determine whether this outlier status is attributable to fraud, waste or abuse or other program violations. FDOs are an advanced data analytics method of identifying issues that may or may not lead to a full-scale investigation.

In February, the Data and Technology team identified pediatric medical providers in the Houston and Dallas regions who exhibited patterns of potential fraud, waste and abuse related to EEG testing. The preliminary investigative findings are currently pending.

More information about the MPI’s work is available in the latest OIG Quarterly Report.