Need To Recover Medicare Part B Duplicate Payments in Illinois

HRD-82-67: Published: Apr 30, 1982. Publicly Released: Apr 30, 1982.

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As part of a GAO review of Medicare contracting to identify specific cases of duplicate payments and to help facilitate the recovery of these overpayments, GAO developed a computer program which identified a substantial number of actual and potential duplicate payments made by an Illinois carrier.

Of the line items which GAO reviewed, 57 percent represented duplicate payments with allowed amounts totaling about $21,000. GAO also identified more than 24,000 potential duplicate line-item payments with allowed amounts totaling more than $2 million. Very few of the duplicate payments had been returned by the beneficiary or provider or otherwise recovered. Medicare instructions provide for the computer to automatically deny a line item if it is an exact duplicate of a line item that has already been processed. However, in some cases, two line items may not be entered exactly the same even though both represent the same service. Because of this, carriers are required to have edits for potential duplicates, and suspect line items are reviewed manually by carrier clerical personnel. For a sample of about 10 percent of the Medicare beneficiaries, 19,706 pairs of line items met the GAO criteria for possible duplicate payments. The carrier could provide complete information on only 32 of 39 pairs for which GAO requested additional information. GAO could not determine why 34 exact matches of duplicate line-item payments were not automatically denied. Claims review procedures did not require that claims examiners be given copies of both claims when a claim is suspended for manual review. Therefore, carrier personnel could not accurately determine if the second claim should be paid. Except for the exact duplicates, the duplicate payment cases GAO identified resulted in large part from clerical errors.

Recommendations for Executive Action

  1. Status: Closed - Implemented

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

    Recommendation: The Secretary of Health and Human Services should ensure that timely action is taken to review the more than $2 million in potential duplicate payments which GAO identified along with those claims with which Electronic Data Systems Federal Corporation experienced processing problems in December 1979.

    Agency Affected: Department of Health and Human Services

  2. Status: Closed - Implemented

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

    Recommendation: The Secretary of Health and Human Services should ensure that timely action is taken to recover the overpayments identified.

    Agency Affected: Department of Health and Human Services

 

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