Review of Potentially Excessive Medicare Payments United Government Services

EXECUTIVE SUMMARY:

The objective of this review was to identify potentially excessive Medicare payments made to institutional providers for outpatient services during Calendar Year (CY) 2000.  We initially brought the issue of excessive payments to the attention of the Centers for Medicare and Medicaid Services (CMS) in our report entitled Review of Potentially Excessive Medicare Payments for Outpatient Services (A-01-00-00502) , dated May 16, 2001.  Our current review is a follow up on the prior issues we identified.  The UGS is one of four fiscal intermediaries we have selected for the follow up review.  Based on a computer application, we identified 13 outpatient claims reimbursed by UGS where the number of units or services billed appeared to be excessive.  Our analysis showed that provider-billing errors on six renal dialysis facility claims resulted in incorrect payments amounting to $386,577.  We also identified seven outpatient hospital claims submitted by one provider where the pharmacy charges totaled over $1.3 million.

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