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Department of Health and Human Services

Office of Inspector General -- AUDIT

"Audit of Medicare Part B Services Billed by California's Developmental Centers and State Hospitals for the Period January 1, 1993 Through June 30, 1997," (A-09-98-00072)

May 24, 2000


Complete Text of Report is available in PDF format (1.73 MB). Copies can also be obtained by contacting the Office of Public Affairs at 202-619-1343.

EXECUTIVE SUMMARY:

This final report discloses that California's Department of Developmental Services (DDS) was overpaid for 73 of 100 statistically sampled services. The point estimate of the overpayments was $13,046,880 for the 4 year period ended June 30, 1997. Fifty-nine of the sampled services were denied, and 14 were allowed but at lesser amounts. We recommend that the carrier develop with the Health Care Financing Administration's guidance a monitoring plan to ensure that DDS' future claims are brought into compliance with Medicare's rules. We also recommended that the identified overpayment not be recovered at this time pending further review by the OIG.