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Audit (A-05-13-00029)

10-29-2014
Medicare Overpayments in Jurisdiction 15 for Unreported Cardiac Device Credits

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Summary

Payments that CGS Administrators, LLC (CGS), made to hospitals in Jurisdiction 15 for 86 of the 641 inpatient and outpatient claims for replaced cardiac medical devices were not correct. These incorrect payments resulted in overpayments of $548,000 that the hospitals had not identified, refunded, or adjusted by the beginning of our audit. Before our fieldwork, hospitals had refunded $19,000 for another five claims. The remaining 550 claims were correct.

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Exclusions Database Report Fraud

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