Assist Audit of the Health Care Financing Administration's Fiscal Year 1998 Financial Statements at First Coast Service Options, Inc.

EXECUTIVE SUMMARY:

First Coast Service Options, Inc. (FCSO) serves as both the Medicare fiscal intermediary and carrier for the State of Florida. Our review was made to determine whether Medicare claims paid by FCSO were reimbursed in accordance with Medicare laws and regulations. With the assistance of FCSO and peer review organization medical review personnel, we identified overpayments totaling $10,105 for these claims during the first quarter of Fiscal Year 1998--our audit period. The overpayments occurred for various reasons, including insufficient documentation, incorrect coding of procedures, and lack of medical necessity. We recommended a financial adjustment. The FCSO officials agreed and have initiated recovery action.