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Audit (A-03-11-00005)

11-30-2011
Review of Medicare Payments Exceeding Charges by $500 to $1,000 for Outpatient Services Processed by National Government Services but Transitioned to Palmetto GBA, LLC, in Jurisdiction 11 for the Period January 1, 2006, Through June 30, 2009

Executive Summary

Our audit found that 491 of the 915 selected line items for which National Government Services (NGS) made Medicare payments to providers for outpatient services for the period January 1, 2006, through June 30, 2009, were incorrect. We addressed our findings and recommendations to Palmetto GBA, LLC, because it has assumed responsibility for claims paid by NGS. The line items included overpayments totaling approximately $447,000 that the providers had not refunded by the beginning of our audit. Providers refunded overpayments on 193 line items totaling approximately $125,000 before our fieldwork. The remaining 231 line items were correct.

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