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Department of Health and Human Services

Office of Inspector General -- AUDIT

"Follow-up Review of the Health Care Financing Administration's Efforts to Assure Employer Group Health Plan Compliance with Medicare Secondary Payer Data Match Requirements," (A-02-98-01036)

July 18, 2000


Complete Text of Report is available in PDF format (1.82 MB). Copies can also be obtained by contacting the Office of Public Affairs at 202-619-1343.

EXECUTIVE SUMMARY:

The Health Care Financing Administration (HCFA) contacts employers for group health plan information on employees covered by Medicare. The HCFA has obtained group health plan information from approximately 1.7 million employers, which represent about 87 percent of the employers contacted from 1991 through 1997. The use of this employer provided group health plan information has resulted in approximately $2.5 billion in Medicare secondary payer (MSP) savings. However, the HCFA has not used all available remedies to obtain this information from the remaining 13 percent of employers who have chosen not to respond to the legislatively mandated request for information. As a result of not having this data, we estimate that HCFA has paid out as much as $282 million in Medicare funds for which group health insurance plans were liable. In this final report to HCFA we recommended, among other things, that HCFA assess civil monetary penalties against employers who refuse to respond to the requests for group health plan information on Medicare beneficiaries. The HCFA concurred with our recommendations and has agreed to take corrective action.