Review of Medicare and Medicaid Duplicate Payments in Michigan

HRD-83-43: Published: Feb 22, 1983. Publicly Released: Feb 22, 1983.

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GAO reviewed the practices and procedures of the Michigan Medicare carrier and Medicaid administrator to prevent duplicate payments to physicians with more than one provider identification number and to remove unlicensed physicians from the Medicare and Medicaid rolls.

GAO found that: (1) duplicate payments of about $39,000 were made to Medicare providers with multiple-provider numbers; (2) duplicate payments of about $24,900 were made to Medicaid providers with multiple-provider numbers; (3) estimated overpayments of about $74,850 were made to surgical assistants and anesthesiologists for Medicare-covered services; and (4) improper payments of about $13,000 were made to unlicensed physicians for Medicare-covered services. GAO also found that few erroneous payments were voluntarily returned by providers or beneficiaries, or otherwise recovered. GAO noted that the State is redesigning its enrollment system to implement a single-provider-number system to eliminate duplicate billings.

Recommendations for Executive Action

  1. Status: Closed - Implemented

    Comments: As of April 1984, the carrier and State had recovered or obtained a court judgment to recover $923,537 in Federal and State funds and has also collected interest of $5,850. A net Federal collection of $469,464 has occurred.

    Recommendation: The Administrator, Region V, Health Care Financing Administration, should ensure that appropriate corrective actions are taken by the carrier and State to recover the erroneous payments identified and to update the provider rolls.

    Agency Affected: Department of Health and Human Services: Health Care Financing Administration: Region V, Chicago, IL

  2. Status: Closed - Implemented

    Comments: Carrier claims examiners were instructed on the proper duplicate payments. The carrier also revised its procedures for such claims.

    Recommendation: The Administrator, Region V, Health Care Financing Administration, should ensure that the carrier improves its manual review process.

    Agency Affected: Department of Health and Human Services: Health Care Financing Administration: Region V, Chicago, IL

 

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