Department of Health and Human Services

Office of Inspector General -- AUDIT

"Review of High-Dollar Payments for Missouri Medicare Part B Claims Processed by Pinnacle Business Solutions, Inc., for the Period January 1, 2003, Through December 31, 2003," (A-06-07-00086)

December 28, 2007


PDF File Complete Text of Report is available in PDF format (281 kb). Copies can also be obtained by contacting the Office of Public Affairs at 202-619-1343.


EXECUTIVE SUMMARY:

The objective of this review was to determine whether Pinnacle Business Solutions, Inc.ís (Pinnacle) high-dollar Medicare payments to Missouri Part B providers were appropriate.  Of the 59 high-dollar payments that Pinnacle made to providers, 46 were appropriate. However, Pinnacle overpaid providers $65,506 for the remaining 13 payments.  Providers stated that they had refunded two of the overpayments, totaling $17,643, prior to our fieldwork; however, Pinnacle had not received the refund for one claim with an overpayment totaling $14,440.  Eleven overpayments, totaling $47,863, remained outstanding.  We recommended that Pinnacle recover the $47,863 in overpayments identified during our audit, process the corrected claim and recover the $14,440 overpayment that the provider stated that it had corrected prior to our audit but Pinnacle had not received, review for accuracy claims that had a charged amount equal to the allowed amount, and consider using the results of this audit in its provider education activities.  Pinnacle agreed with the findings and recommendations.