Survey of Medicare Payments to Worker's Compensation Recipients in the State of Florida

January 10, 2003

EXECUTIVE SUMMARY:

The objective of this survey was to determine whether the Medicare program might be paying for services that should be covered by the Florida Workers' Compensation (WC) program.  Our survey indicated that there is a high vulnerability of the Medicare program to erroneous payments being made to WC beneficiaries in Florida.  We recommended that the Centers for Medicare & Medicaid Services (CMS) Region IV:  continue to implement procedures within the regional office for acquiring, tracking, evaluating, and responding to WC settlements; provide training to regional office staff and to contractor staff responsible for reviewing WC settlements; establish a point of contact with a representative of the Florida Division of WC, and persuade the individual of the need for CMS to have access to State WC records on a continual basis in order to match potential claims; and consider the ICD-9 diagnosis codes that we identified in this survey as being associated with WC claims in the State, in developing any future edits that may be implemented by CMS.  The CMS Region IV generally concurred with our findings and recommendations.