Review of Selected Part B Medicare Secondary Payer Activities at Blue Shield of Florida

EXECUTIVE SUMMARY:

This report points out that reduced funding for Medicare secondary payer (MSP) activities resulted in Blue Shield of Florida (BSF) not pursuing, for recovery, previously identified MSP overpayments. We also noted that due to an increase in the Medicare Part B claims threshold, potential MSP cases are not being identified. As a result, claims totaling $24.3 million were paid for beneficiaries who, according to BSF records, were known to have other insurance coverage. We also identified an estimated $2.6 million of improper primary payments for which BSF was notified by providers, insurers, and beneficiaries that improper payments were made. In addition to financial adjustments, we recommended that the Health Care Financing Administration pursue alternative funding strategies to provide the needed resources to identify and recover the improper payments.