Report Materials
Our objective was to determine whether Group Health Incorporated's (GHI) high-dollar Medicare payments to Part B providers were appropriate. During calendar years 2003'2005, GHI processed 14 Part B payments of $10,000 or more. Eleven of the fourteen high-dollar payments that GHI made to providers were appropriate. However, Group Health Incorporated overpaid providers $84,092 for the remaining three payments. Providers refunded two of the overpayments, totaling $69,394, prior to our fieldwork, and one overpayment of $14,698 remained outstanding.
We recommended that GHI (1) recover the $14,698 overpayment and (2) consider identifying and recovering any additional overpayments made for high-dollar Part B claims paid after calendar year 2005. GHI agreed with our recommendations.
Notice
This report may be subject to section 5274 of the National Defense Authorization Act Fiscal Year 2023, 117 Pub. L. 263.