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Audit (A-03-07-00012)

Review of High-Dollar Payments for Maryland and District of Columbia Outpatient Claims Processed by CareFirst of Maryland for the Period January 1, 2003, Through September 30, 2005

Executive Summary

CareFirst of Maryland (CareFirst) overpaid $1.2 million for 24 high-dollar payments it made for hospital outpatient claims in Maryland and the District of Columbia. Overpayments totaling $1.1 million were refunded either prior to or during our audit. Highmark assumed operations as Medicare fiscal intermediary for Maryland and the District of Columbia on October 1, 2005, and has initiated recovery of the remaining overpayments totaling $111,000.

Complete Report

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