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Review of Excessive Payments for Inpatient Services Processed by National Government Services in Michigan and Wisconsin for Calendar Years 2004 and 2005

Of the 172 high-dollar payments ($200,000 or more) that National Government Services, a Medicare fiscal intermediary, made to hospitals for inpatient services for calendar years 2004 and 2005, 65 were appropriate. The remaining 107 payments included net overpayments totaling $1.6 million, of which $1.3 million for 105 payments had not been repaid at the start of our audit.

We recommended that National Government Services recover the $1.3 million in identified overpayments, use the results of this audit in its provider education activities related to data entry procedures and proper documentation of charges, and consider implementing controls to identify and review all payments greater than $200,000 for inpatient services. National Government Services agreed with our recommendations and stated that the 105 outstanding claims were adjusted and monies were recovered by April 30, 2008.

Filed under: Centers for Medicare and Medicaid Services