Department of Health and Human Services

Office of Inspector General -- AUDIT

"Review of High-Dollar Payments for Medicare Part B Claims Processed by Group Health Incorporated for the Period January 1, 2003, Through December 31, 2005," (A-02-07-01045)

January 4, 2008


PDF File Complete Text of Report is available in PDF format (305 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 Group Health Incorporated’s (GHI) high-dollar Medicare payments to Part B providers were appropriate.  During calendar years 2003–2005, GHI processed 14 Part B payments of $10,000 or more.  Eleven of the fourteen high-dollar payments that GHI made to providers were appropriate.  However, Group Health Incorporated overpaid providers $84,092 for the remaining three payments.  Providers refunded two of the overpayments, totaling $69,394, prior to our fieldwork, and one overpayment of $14,698 remained outstanding. 

We recommended that GHI (1) recover the $14,698 overpayment and (2) consider identifying and recovering any additional overpayments made for high-dollar Part B claims paid after calendar year 2005.  GHI agreed with our recommendations.