Department of Health and Human Services

Office of Inspector General -- AUDIT

"Review of Excessive Payments for Inpatient Services Processed by TrailBlazer Health Enterprises for the Period January 1, 2003, Through December 31, 2003," (A-06-07-00055)

April 8, 2008


PDF File Complete Text of Report is available in PDF format (842 kb). Copies can also be obtained by contacting the Office of Public Affairs at 202-619-1343.


EXECUTIVE SUMMARY:

Of the 147 high-dollar payments ($200,000 or more) that TrailBlazer Health Enterprises (TrailBlazer) made to Medicare Part A providers in calendar year 2003, 11 were overpayments, 8 of which resulted in net overpayments totaling $50,044.  For the remaining three overpayments, providers agreed that they had submitted incorrect claims and said that they would submit revised claims.  TrailBlazer is a fiscal intermediary serving Medicare providers in Texas, New Mexico, and Colorado.

We recommended that TrailBlazer (1) ensure that identified overpayments have been recovered, (2) follow up with the providers about the three claims that had not been revised, (3) use the results of this audit in its provider education activities, and (4) consider identifying and recovering any additional overpayments made for high-dollar Part A inpatient claims paid after calendar year 2003.  TrailBlazer agreed with our findings and stated that providers had corrected and resubmitted 10 of the 11 claims.