Review of Medicare Credit Balances--Blue Cross Blue Shield of Maryland

EXECUTIVE SUMMARY:

This final report summarizes the results of our review of Medicare accounts receivable with credit balances at eight hospitals serviced by Blue Cross Blue Shield of Maryland (BCBSM). Our reviewed showed that the eight hospitals were not routinely reviewing Medicare credit balance accounts to identify Medicare overpayments that should be refunded to BCBSM. As a result the eight hospitals received and retained overpayments of $1,323,071. Projecting the results to 39 of the 40 hospitals serviced by BCBSM, we estimate that the 39 hospitals received and retained Medicare overpayments of $6,908,403.