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Audit (A-03-11-00004)

8-12-2011
Review of Medicare Payments Exceeding Charges By $500 to $1,000 for Outpatient Services Processed by Highmark Medicare Services in Jurisdiction 12 for the Period January 1, 2006, Through June 30, 2009

Executive Summary

Our audit found that 418 of the 739 selected line items for which Highmark Medicare Services (Highmark) made Medicare payments to providers for outpatient services for the period January 1, 2006, through June 30, 2009, were incorrect. The line items included overpayments totaling approximately $532,000 that the providers had not refunded by the beginning of our audit. Providers refunded overpayments on 41 line items totaling approximately $31,000 before our fieldwork. The remaining 280 line items were correct.

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