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Medicare Paid New England Providers Twice for Nonphysician Outpatient Services Provided Shortly Before or During Inpatient Stays During Calendar Years 2013 and CY 2014

Medicare payments to New England providers were not always correct for nonphysician outpatient services provided within 3 days prior to the date of admission, on the date of admission, or during Inpatient Prospective Payment System stays. For 75 of the 129 services we sampled, Medicare paid providers twice, resulting in total overpayments of $288,000. Based on our sample results, we estimated that the Medicare contractor made approximately $1.3 million in overpayments to hospital outpatient providers during calendar years 2013 and 2014.

We recommended that National Government Services (1) recover the portion of the $288,000 in identified overpayments from the 41 providers for the 75 incorrectly billed services; (2) notify the 41 providers of potential additional overpayments and identify and track any returned overpayments; (3) notify the 129 providers responsible for the remaining 21,606 nonsampled line items with potential overpayments estimated at $1 million so that those providers can exercise reasonable diligence to investigate and return any identified overpayments and identify and track any returned overpayments as having been made in accordance with this recommendation; and (4) educate all of its providers of their responsibilities under Medicare requirements to bill accurately for inpatient and outpatient services to prevent improper payments.

National Government Services fully concurred with all of our recommendations.