Review of Duplicate Medicare Fee-for-Service Payments at Capital Health Plan

EXECUTIVE SUMMARY:

This final report presents the results of an Office of Inspector General (OIG), Office of Audit Services, review of duplicate Medicare fee-for-service (FFS) payments at Capital Health Plan (CHP).  Our review indicated that Medicare FFS made $30,283 in erroneous payments by paying for services that were claimed on CHP's 1999 cost report and that were also billed directly to Medicare.  Because Medicare paid physicians directly for these services, and reimbursed CHP for its expenses related to paying for the services, Medicare has paid twice for the same services.  The OIG recommends that CHP refund the $30,283 in overpayments made on behalf of CHP enrollees.