Medicare 2002 Financial Statement Activity at Mutual of Omaha

EXECUTIVE SUMMARY:

The objectives of this audit were to determine whether Medicare fee-for-service claims were: furnished by certified Medicare providers to eligible beneficiaries; reimbursed by Medicare contractors in accordance with Medicare laws and regulations; and medically necessary, accurately coded, and sufficiently documented in the beneficiaries' medical records.  The period of this audit was the quarter of January 2002 through March 2002.  Our review of 151 claims totaling $530,367 of Medicare payments disclosed that 25 claims did not comply with Medicare laws and regulations.  The 25 claims had 133 line errors representing $12,070 in improper payments and one underpayment of $7,016.  All of these improper payments were detected by medical reviews coordinated by the Office of Inspector General.