The Medicare Contractor's Payments to Maryland Providers in Jurisdiction 12 for Full Vials of Herceptin Were Sometimes Incorrect

Some payments for one or more full vials of Herceptin that the Medicare contractors made to Maryland providers in Jurisdiction 12 were incorrect. Of the 1,113 selected line items, 319 were incorrect and included overpayments totaling $352,000 that the providers had not identified or refunded by the beginning of our audits.

These overpayments occurred because providers billed for incorrect units of service for 307 line items, billed for units of services for 11 line items for which they did not provide supporting documentation, and reported the incorrect billed charges on 1 line item. The Medicare contractors' systems did not have edits in place to prevent or detect the incorrect billing.