CMS and DOJ are Scrutinizing Medicare Billings for Amniotic Injections

The Centers for Medicare and Medicaid Services (CMS) and U.S. Department of Justice (DOJ) are scrutinizing health care providers’ Medicare billings for amniotic injections. These injections are only eligible for Medicare reimbursement in limited circumstances, and providers that bill Medicare for non-reimbursable amniotic injections are at risk for facing allegations of Medicare fraud.

Among other means of enforcement, the DOJ has begun sending civil investigative demands (CIDs) to health care providers suspected of improperly billing Medicare for amniotic injections. These are administrative subpoenas that do not require judicial approval, but are subject to judicial enforcement. CMS is also instructing its fee-for-service auditors to pay attention to providers’ amniotic injection billings; and, due to the limited purposes for which these injections are eligible for Medicare reimbursement, many providers that have high volumes of these billings are at risk for facing substantial recoupment liability.

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