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Audit (A-03-07-00011)

08-14-2009
Review of High-Dollar Payments for Pennsylvania Outpatient Claims Processed by Highmark Medicare Services for Calendar Years 2003-2005

Executive Summary

Highmark Medicare Services (Highmark) overpaid $2.2 million for 28 high-dollar payments it made for hospital outpatient claims in Pennsylvania. Overpayments totaling $1.5 million were refunded either prior to or during our audit. Highmark has initiated recovery of the remaining overpayments totaling $632,000.

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