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Review of Outpatient Claims Processed by Wisconsin Physicians Service That Included Procedures for the Insertion of Multiple Units of the Same Type of Medical Device in Calendar Years 2008 and 2009

Of the 14 claims that we reviewed, Medicare paid 8 correctly for outpatient claims processed by Wisconsin Physicians Service (WPS) that included procedures for the insertion of multiple units of the same type of medical device. However, for the remaining six claims, WPS made overpayments to hospitals totaling approximately $18,000. Incorrect payments occurred because hospitals had inadequate controls to ensure that they billed accurately for claims that included the insertion of medical devices. In addition, Medicare payment controls in the Fiscal Intermediary Shared System were not always adequate to prevent or detect incorrect payments.