Review of Potentially Excessive Medicare Payments - Empire Medicare Services

EXECUTIVE SUMMARY:

The objective of this review was to identify potentially excessive Medicare payments made to institutional providers for outpatient and Part B services during Calendar Years 2000 and 2001.  Based on a computer application, we identified outpatient claims and inpatient claims reimbursed under Medicare Part B that had paid amounts equaling or exceeding $50,000.  Further analysis identified isolated instances when the number of service units or amounts billed appeared to be excessive or unsupported.  In this respect, Empire Medicare Services initiated recovery action for three claims totaling $179,510.

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