Review of Backlog of Medicare Secondary Payer Claims

EXECUTIVE SUMMARY:

This final report contains the results of our review of the Health Care Financing Administration's (HCFA) oversight pertaining to the reporting of Medicare secondary payer (MSP) backlog claims. We concluded that the contractor's backlog reports were not filed timely nor was the information being reviewed and verified by HCFA. Because of the lack of internal controls, there was inadequate management oversight on contractors to ensure that the regulatory deadline imposed on the collection of MSP overpayments is met once the primary payer has been identified. Our review shows that based on the contractor backlog reports, the Medicare program could lose approximately $445 million if contractors do not notify the liable primary insurers by December 31, 1992.