Department of Health and Human Services

Office of Inspector General -- AUDIT

"Review of High-Dollar Payments for Medicare Part B Claims Processed by National Government Services for New Jersey Providers for the Period January 1, 2003, Through December 31, 2005," (A-02-07-01044)

May 5, 2008


PDF File Complete Text of Report is available in PDF format (710 kb). Copies can also be obtained by contacting the Office of Public Affairs at 202-619-1343.


EXECUTIVE SUMMARY:

National Government Services overpaid Medicare providers $109,000 for 7 of the 100 high-dollar payments ($10,000 or more) in our statistical sample for calendar years (CY) 20032005. The 93 remaining sampled payments were appropriate.  National Government Services, the Medicare Part B carrier for about 38,000 providers in New Jersey, processed 1,265 high-dollar payments during the audit period.  Providers refunded four overpayments totaling $96,000 prior to our fieldwork and one $10,000 overpayment during our fieldwork.  Two overpayments totaling $2,800 remained outstanding.

We recommended that National Government Services (1) recover the $2,800 in overpayments,  (2) review the remaining 1,165 high-dollar claims processed during CYs 20032005 with potential overpayments estimated at $1.27 million ($1.37 million less $109,000) and work with the providers that claimed these services to recover any overpayments, (3) consider identifying and recovering any additional overpayments made for high-dollar Part B claims paid after CY 2005, and (4) use the results of this audit in its provider education activities.  National Government Services agreed with our recommendations.