The U.S. Department of Justice’s office in the Western District of New York is reviewing potentially medically unnecessary inpatient admissions for chest pain. The issue initially was identified by the ZPIC for New York state and referred to the MAC. The DOJ is basing its investigation on results of the MAC audits, including unnecessary admissions identified by the MAC for which hospitals have returned overpayments. It also is investigating errors identified by the Recovery Audit Contractor to determine if specific claims rise to the level of fraud.
For now, this investigation is limited to chest pain admissions in 2008 at 24 New York hospitals, although it could become a more in-depth collaboration between the DOJ and program-integrity contractors. Remember – this is the same DOJ office that coordinated the national kyphoplasty investigation.