U.S. flag

An official website of the United States government

Dot gov

The .gov means it's official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you're on a federal government site.


The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Department of Health and Human Services

Office of Inspector General -- AUDIT

"Results of Audit Work Performed at Arkansas Blue Cross and Blue Shield as Part of the Office of Inspector General's Nationwide Determination of the Fiscal Year 2001 Medicare Error Rate," (A-06-02-00032)

November 20, 2002

Complete Text of Report is available in PDF format (907 kb). Copies can also be obtained by contacting the Office of Public Affairs at 202-619-1343.


This audit provides the results of our audit work performed at Arkansas Blue Cross and Blue Shield (Arkansas BCBS) as part of the Office of Inspector General's (OIG) nationwide determination of the Fiscal Year (FY) 2001 Medicare error rate.  Arkansas BCBS was selected by the OIG through statistical sampling as one of the Centers for Medicare and Medicaid Services (CMS) contractors to be audited as part of the FY 2001 nationwide audit.  The audit period covered the third quarter of FY 2001 (April 1, 2001 through June 30, 2001). 

Our audit work disclosed three areas where Arkansas BCBS could improve its operations.  These areas centered on the reconciliation requirements of both the CMS 1521 and CMS 1522.  In addition, the medical review of the 788 claims selected in our statistical sample identified 65 claims that did not comply with Medicare laws and regulations, resulting in net questioned costs totaling $9,654.91 that needs to be refunded to Medicare.  We recommended that Arkansas BCBS perform a monthly reconciliation of the funds expended as reported on the CMS 1522 to the Medicare paid claims history file; and take the steps needed to ensure that adjustments are made to those claims in our sample that contained errors and that the net adjustment amount of $9,654.91 is refunded to Medicare.  Arkansas BCBS officials agreed with our recommendations.