Department of Health and Human Services
Office of Inspector General -- AUDIT
"Review of High-Dollar Payments for Delaware Medicare Part B Claims Processed by TrailBlazer Health Enterprises for the Period January 1, 2003, Through December 31, 2005," (A-03-07-00018)
June 19, 2008
Complete Text of Report is available in PDF format (177 kb). Copies can also be obtained by contacting the Office of Public Affairs at 202-619-1343.
TrailBlazer Health Enterprises (TrailBlazer) overpaid providers $40,000 for
two of the three high-dollar payments ($10,000 or more) for calendar years (CY)
2003-05. The remaining payment was appropriate. TrailBlazer, the Medicare
Part B carrier for Delaware, processed three high-dollar payments during the
audit period. Providers refunded the two overpayments prior to our
We recommended that TrailBlazer consider identifying and recovering any additional overpayments made to providers for high-dollar Part B claims paid after CY 2005. TrailBlazer stated that it had implemented multiple internal controls since 2003, including the addition of an edit to review high-dollar Part B claim in June 2005. However, because it does not receive funding to do so, it would not identify and recover any additional overpayments for high-dollar Part B claims paid after CY 2005.