Results of Audit Work Performed at Trailblazer Health Enterprises, LLC as part of the Office of Inspector General's Nationwide Determination of the Fiscal Year 2002 Medicare Error Rate

EXECUTIVE SUMMARY:

This audit report provides the results of our audit work performed at TrailBlazer Health Enterprises, LLC (TrailBlazer) as part of the Office of Inspector General's nationwide determination of the fiscal year (FY) 2002 Medicare error rate.  Our audit work at TrailBlazer was limited to: (1) identifying all of the Medicare claims paid during the FY 2002 first quarter; (2) verifying the accuracy of Medicare benefit payments and other data reported by TrailBlazer to the Centers for Medicare and Medicaid Services (CMS); and, (3) reviewing, with assistance from the TrailBlazer medical staff and the Texas and New Mexico Quality Improvement Organizations, a statistical sample of Medicare beneficiary expenditures paid during the first quarter for compliance with Medicare requirements.  We identified several areas where TrailBlazer reported incorrect information to CMS.  In addition, we noted improper claims that resulted in net questioned costs totaling approximately $93,863.  We recommended correction of procedural weaknesses and a financial adjustment for the $93,863.