Review of Excessive Payments for Outpatient Services Processed by National Government Services for Calendar Years 2004 and 2005 - Illinois, Indiana, Kentucky and Ohio

Our objective was to determine whether high-dollar Medicare payments that National Government Services made to providers for outpatient services were appropriate. Most of the high-dollar Medicare outpatient payments were not appropriate. For calendar years 2004 and 2005 claims, National Government Services made 79 payments of $50,000 or more for outpatient services. Our analysis indicated that only 13 payments were correct and the remaining 66 payments were inappropriate. At the start of our fieldwork in May 2007, 53 payments, totaling $3,338,895, had been refunded by the providers and 13 payments, totaling $513,796, remained outstanding.

We recommended that National Government Services (1) inform us of the status of the recovery of the $513,796 in overpayments that our audit identified, (2) identify and recover additional overpayments made on high-dollar outpatient claims paid after calendar year 2005, and (3) use the results of this audit in its provider education activities. National Government Services agreed with our recommendations.