Review of Medicare Credit Balances--Independence Blue Cross of Philadelphia, Pennsylvania

EXECUTIVE SUMMARY:

This final report summarizes the results of our review of Medicare outpatient accounts receivable with credit balances at 11 hospitals serviced by Independence Blue Cross (IBC) of Philadelphia, Pennsylvania. Our review showed that hospitals were not routinely reviewing Medicare outpatient credit balance accounts to identify Medicare overpayments that should be refunded to IBC. As a result, 8 of the 11 hospitals received and retained Medicare overpayments estimated at $232,890. Projecting the results to 40 hospitals serviced by IBC, we estimate that the 40 hospitals received and retained Medicare overpayments of $1,249,179.