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.


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 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.


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.