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Audit (A-04-08-00051)

Review of High-Dollar Outpatient Claims Processed by Cahaba Government Benefit Administrators Fiscal Intermediary No. 00010 for the Period January 1, 2004, Through December 31, 2006

Executive Summary

During calendar years 2004-2006, Cahaba Government Benefit Administrators Carrier No. 00010 (Cahaba GBA) overpaid hospitals in Alabama $355,000. Generally, hospitals attributed the overpayments to incorrect claims data. Cahaba GBA made these incorrect payments because neither the Fiscal Intermediary Standard System nor the Common Working File had sufficient edits in place to detect and prevent the overpayments.

We recommended that Cahaba GBA recover the $355,000 in identified overpayments, and Cahaba GBA agreed with the report. Cahaba GBA stated that the recommendation was reasonable and that it would await direction from the Centers for Medicare & Medicaid Services before acting on the recommendation and making adjustments.

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