U.S. flag

An official website of the United States government

Dot gov

The .gov means it's official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you're on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Department of Health and Human Services

Office of Inspector General -- AUDIT

"Review of High-Dollar Payments for Medicare Part B Claims Processed by HealthNow New York, Inc., for the Period January 1, 2003, Through December 31, 2005," (A-02-07-01042)

February 1, 2008


PDF File Complete Text of Report is available in PDF format (347 kb). Copies can also be obtained by contacting the Office of Public Affairs at 202-619-1343.


EXECUTIVE SUMMARY:

Our objective was to determine whether HealthNow New York, Inc.s (HealthNow) high-dollar Medicare payments to Part B providers were appropriate.  During calendar years 20032005, HealthNow processed 268 Part B payments of $10,000 or more.  Of the 268 high-dollar payments that HealthNow made to providers, 249 were appropriate.  However, HealthNow overpaid providers $236,977 for the remaining 19 payments.  Providers refunded eight of the overpayments, totaling $111,575, prior to our fieldwork.  Eleven overpayments, totaling $125,402, remained outstanding. 

We recommended that HealthNow (1) recover the $125,402 overpayment, (2) consider identifying and recovering any additional overpayments made for high-dollar Part B claims paid after calendar year 2005, and (3) use the results of this audit in its provider education activities.  HealthNow agreed with our recommendations.