Updated on: February 4, 2021

PET Scans and Helicopter Transportation  

Original story posted on: February 3, 2021

RACs will soon be auditing PET scans.

The “COVID pause button” on Recovery Audit Contractor (RAC) audits has been lifted, and the RACs are back on the attack. The audits actually restarted back in August 2020, but never have I seen the Centers for Medicare & Medicaid Services (CMS) dish out so many new RAC topics in the first month of a new year. Happy 2021!

RACs will soon be auditing positron emission tomography (PET) scans for initial treatment strategy in oncologic conditions for compliance with medical necessity and documentation requirements.

PET scans detect early signs of cancer, heart disease, and brain disorders. An injectable radioactive tracer detects diseased cells. A combination PET-CT scan produces 3D images for a more accurate diagnosis.

According to CMS’s RAC audit topics, “(PET) for Initial Treatment Strategy in Oncologic Conditions: Medical Necessity and Documentation Requirements” will be reviewed as of Jan. 5, 2021. The PET scan audits will be for outpatient hospital and professional service reviews. CMS added these other 2021 audit targets to the approved list:

  • Air Ambulance: Medical Necessity and Documentation Requirements (this complex review will focus on helicopter claims to determine if air ambulance transport was reasonable and medically necessary, as well as whether documentation requirements have been met);
  • Hospice Continuous Home Care: Medical Necessity and Documentation Requirements; and
  • Ambulance Transport Subject to SNF Consolidated Billing.

Incoming U.S. Department of Health and Human Services (HHS) Secretary Xavier Becerra plans to get his new tenure underway quickly.

In False Claims Act (FCA) news, Medicare audits of the P-Stim auricular electroacupuncture device have ramped up across the country. A spinal clinic in Texas agreed to pay $330,898 to settle FCA allegations for allegedly billing Medicare improperly for electro-acupuncture device neurostimulators. CMS claims that “Medicare does not reimburse for acupuncture or for acupuncture devices such as P-Stim, nor does Medicare reimburse for P-Stim as a neurostimulator or as implantation of neurostimulator electrodes.”

Finally, is your staff getting medical records to consumers requesting their records quickly enough? The right to access health records is yet another potential risk for all providers, especially hospitals, due to their size. A hospital system recently agreed to pay $200,000 to settle potential violations of the HIPAA Privacy Rule’s right-of-access standard. This is the HHS Office for Civil Rights’ 14th settlement under its Right of Access Initiative. The first person alleged that she requested medical records in December 2017 and did not receive them until May 2018. In the second complaint, the person asked for an electronic copy of his records in September 2019, and they were not sent until February 2020.

Beware of slow document production, as it can lead to penalties. And be on the lookout for the next RAC Report.

Programming Note: Listen to Knicole Emanuel and her RAC Report during Monitor Mondays, 10 a.m. Eastern.


Knicole C. Emanuel Esq.

For more than 20 years, Knicole has maintained a health care litigation practice, concentrating on Medicare and Medicaid litigation, health care regulatory compliance, administrative law and regulatory law. Knicole has tried over 2,000 administrative cases in over 30 states and has appeared before multiple states’ medical boards.  She has successfully obtained federal injunctions in numerous states, which allowed health care providers to remain in business despite the state or federal laws allegations of health care fraud, abhorrent billings, and data mining.  Across the country, Knicole frequently lectures on health care law, the impact of the Affordable Care Act and regulatory compliance for providers, including physicians, home health and hospice, dentists, chiropractors, hospitals and durable medical equipment providers. Knicole is partner at Practus, LLP and a member of the RACmonitor editorial board and a popular panelist on Monitor Monday.

This email address is being protected from spambots. You need JavaScript enabled to view it.

Related Articles

  • Proliferation of RAC Meaningful Use Audits
    In this case, more than 50 percent of the practice’s patients refuse to provide an email address or do not have one to provide. Recently, I’ve seen a slew of meaningful use audits. Hospitals go through these audits all the…
  • Credible Allegations of Fraud Yield Immediate Medicare Payment Suspension
    Credible allegations of fraud is a low standard to meet. If you are accused of Medicare fraud, your Medicare reimbursements will be immediately cut off without any due process or ability to defend yourself against the allegations. If you accept…
  • RAC Audits Expected During the COVID Pandemic
    Even though the public health emergency (“PHE”) for the COVID pandemic is scheduled to expire July 24, 2020, all evidence indicates that the PHE will be renewed. I cannot imagine a scenario in which the PHE is not extended, especially…