Review of High-Dollar Payments for New Mexico Medicare Part B Claims Processed by Pinnacle Business Solutions, Inc., for the Period January 1, 2003, Through December 31, 2003

The objective of this review was to determine whether Pinnacle Business Solutions, Inc.'s (Pinnacle), high-dollar Medicare payments to New Mexico Part B providers were appropriate.  Eleven of the 16 high-dollar payments that Pinnacle made to providers were appropriate. However, Pinnacle overpaid providers $39,539 for the remaining five payments.  A provider refunded one overpayment of $1,048 prior to our fieldwork.  Four overpayments totaling $38,491 remained outstanding.  We recommended that Pinnacle recover the $38,491 overpayment and consider using the results of this audit in its provider education activities. Pinnacle agreed with the findings and recommendations.