Review of High-Dollar Payments for Delaware Medicare Part B Claims Processed by TrailBlazer Health Enterprises for the Period January 1, 2003, Through December 31, 2005

TrailBlazer Health Enterprises (TrailBlazer) overpaid providers $40,000 for two of the three high-dollar payments ($10,000 or more) for calendar years (CY) 2003-05.  The remaining payment was appropriate. TrailBlazer, the Medicare Part B carrier for Delaware, processed three high-dollar payments during the audit period.  Providers refunded the two overpayments prior to our fieldwork.

We recommended that TrailBlazer consider identifying and recovering any additional overpayments made to providers for high-dollar Part B claims paid after CY 2005.  TrailBlazer stated that it had implemented multiple internal controls since 2003, including the addition of an edit to review high-dollar Part B claim in June 2005.  However, because it does not receive funding to do so, it would not identify and recover any additional overpayments for high-dollar Part B claims paid after CY 2005.