Review of High-Dollar Payments for Medicare Part B Claims Processed by HealthNow New York, Inc., for the Period January 1, 2003, Through December 31, 2005

Our objective was to determine whether HealthNow New York, Inc.'s (HealthNow) high-dollar Medicare payments to Part B providers were appropriate.  During calendar years 2003'2005, HealthNow processed 268 Part B payments of $10,000 or more.  Of the 268 high-dollar payments that HealthNow made to providers, 249 were appropriate.  However, HealthNow overpaid providers $236,977 for the remaining 19 payments.  Providers refunded eight of the overpayments, totaling $111,575, prior to our fieldwork.  Eleven overpayments, totaling $125,402, remained outstanding. 

We recommended that HealthNow (1) recover the $125,402 overpayment, (2) consider identifying and recovering any additional overpayments made for high-dollar Part B claims paid after calendar year 2005, and (3) use the results of this audit in its provider education activities.  HealthNow agreed with our recommendations.