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Audit (A-04-09-06103)

12-14-2009
Review of Medicare Outpatient Payments for Oxaliplatin in Virginia

Executive Summary

For all 57 Medicare outpatient payments reviewed, seven hospitals billed National Government Services (NGS), a Medicare fiscal intermediary, for the incorrect number of service units of oxaliplatin. Oxaliplatin is a chemotherapy drug used to treat colorectal cancer. As a result of the incorrect billing, the hospitals received overpayments totaling $1.4 million during calendar year 2005. These overpayments occurred primarily because the hospitals did not update their systems following a change in Medicare billing guidance.

We recommended that NGS recover the $1.4 million in overpayments to the hospitals. NGS agreed with our recommendation.

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