Review of Epogen Internal Control Procedures at Massachusetts Renex Dialysis Clinics for Calendar Year 1999

EXECUTIVE SUMMARY:

The objective of this review was to determine if Massachusetts Renex providers have established adequate internal controls and procedures to ensure that claims for EPOGEN (EPO) are supported and billed in accordance with Medicare rules and regulations.  Based on a review of 296 claims valued at $327,540, we identified portions of 85 claims totaling $6,016 not eligible for Medicare reimbursement.  We recommended that Renex (1) continue to strengthen their internal controls and procedures to ensure that the claims submitted for EPO are supported and billed in accordance with Medicare rules and regulations, and (2) refund the Medicare program $6,016 for unallowable Medicare costs to the fiscal intermediary BC/BS of Georgia.

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