Audit of Medicare Part B Services Billed by Community Urgent Care Medical Group for the Period January 1, 1995 through July 31, 1999

The objective of our audit was to examine the Medicare Part B payments for services billed by Community Urgent Care Medical Group (Community) for the period January 1, 1995 through July 31, 1999 to determine if the payments (about $3.7 million) were appropriate.  Our review disclosed that 29 services in our random, statistical sample of 100 claims (135 services) were overpaid.  The 29 overpaid services included 23 which had been upcoded, 3 for which the documentation did not support the services billed, and 3 for which the documentation did not support that a teaching physician was present when a resident performed the service.  Based upon our random sample, we estimate that Community received $266,236 in Medicare overpayments during the audit period.  We are recommending that Community refund the identified overpayment.