June 30, 2003
An investigation being conducted by the Baton Rouge, Louisiana, Suboffice has identified a physician who billed for myocardial perfusion imaging tests which require the administration of nuclear medicine. The claims indicated that the services, Physicians' Current Procedural Terminology codes 78460 and 78461, were performed in the physician's office. The physician did not have the equipment needed to perform the test and was not licensed to maintain nuclear medicine or radioactive material.
The investigation revealed that myocardial perfusion imaging tests are usually conducted in a hospital or a large clinic because the equipment necessary to perform the test is very expensive and the hospital is licensed to handle nuclear medicine. Some States require that a license be obtained for each facility which maintains nuclear medicine or handles radioactive material.
Field Offices and carriers should review a sample of claims for diagnostic services that require administration of nuclear medicine. The reviews should determine the actual place of service and confirm that the provider has a license to maintain nuclear medicine.
John E. Hartwig
Deputy Inspector General for Investigations
Fraud Alert OIG97-02