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Audit (A-01-10-00515)

Review of Outpatient Claims Processed by Trailblazer Health Enterprises, LLC That Included Procedures for the Insertion of Multiple Units of the Same Type of Medical Device in Calendar Years 2008 and 2009

Executive Summary

Of the 101 claims that we reviewed for calendar years 2008 and 2009, Medicare paid 28 incorrectly for outpatient claims processed by TrailBlazer Health Enterprises, LLC, that included procedures for the insertion of multiple units of the same type of medical device. These incorrect payments were due to hospitals overstating the number of units and related charges, resulting in net overpayments to hospitals totaling $82,000.

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