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Audit (A-01-11-00523)

Review of Outpatient Claims Processed by First Coast Service Options, Inc., 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 18 claims that we reviewed, Medicare paid 13 correctly for outpatient claims processed by First Coast Service Options, Inc. (First Coast), that included procedures for the insertion of multiple units of the same type of medical device. However, for the remaining five claims, First Coast made overpayments to hospitals totaling $17,000. 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.

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