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Review of High-Dollar Payments for Inpatient Services Processed by National Government Services in Illinois, Indiana, Kentucky, and Ohio for Calendar Years 2004 Through 2006

Of the 303 high-dollar payments that National Government Services made to hospitals for inpatient services for calendar years 2004 through 2006, 39 were appropriate. The remaining 264 payments included net overpayments totaling $7.4 million. At the start of our audit, hospitals had refunded overpayments totaling $2.8 million for 4 claims but had not refunded net overpayments totaling $4.7 million for 260 claims.

We recommended that National Government Services (1) recover the $4.7 million in identified net overpayments, (2) use the results of this audit in its provider education activities related to data entry procedures and proper documentation, and (3) consider implementing controls to identify and review all payments greater than $200,000 for inpatient services. In its written comments, National Government Services agreed with our recommendations.

Filed under: Centers for Medicare and Medicaid Services