Medicare:

Millions in Potential Recoveries Not Being Sought by Maryland Contractor

HRD-91-32: Published: Jan 25, 1991. Publicly Released: Jan 25, 1991.

Additional Materials:

Contact:

Janet L. Shikles
(202) 512-7119
contact@gao.gov

 

Office of Public Affairs
(202) 512-4800
youngc1@gao.gov

GAO evaluated the adequacy of the Health Care Financing Administration's (HCFA) Medicare contractor budget for claims processing and program safeguard activities, focusing on the Maryland Medicare claims processing contractor's: (1) payment of claims for which other health insurers may have had primary payment responsibility under the Medicare secondary payer (MSP) program; and (2) efforts and resources for pursuing MSP recoveries.

GAO found that: (1) the Maryland Medicare contractor paid at least $8.8 million in Medicare claims that primary insurers should have paid under MSP provisions; (2) 13 insurers were each potentially responsible for more than $100,000 of the health care payments, and the Maryland Medicare contractor, as a private primary health insurer, was potentially responsible for $4.1 million of the payments; (3) the contractor did not pursue the large inventory of potential recoveries due to reductions in funds for MSP activities, and had only 1.5 full-time-equivalent staff assigned to recover mistaken MSP payments; and (4) the contractor estimated that, with an additional $200,000 for needed staff, it could eliminate the total MSP backlog in 1 year.

Recommendations for Executive Action

  1. Status: Closed - Implemented

    Comments: The Medicare contractor has recouped $6.2 million in overpayments.

    Recommendation: The Administrator, HCFA, should work with the Medicare contractor to: (1) determine the full scope of the problem and the resources needed to correct it; and (2) establish a plan, including milestones, for seeking recoveries.

    Agency Affected: Department of Health and Human Services: Health Care Financing Administration

  2. Status: Closed - Implemented

    Comments: The HCFA Philadelphia Regional Office received a final report from the contractor on March 3, 1993, that accounted for all of the amounts identified by GAO.

    Recommendation: The Administrator, HCFA, should closely monitor the Medicare contractor's performance in meeting the milestones set for the recovery activity.

    Agency Affected: Department of Health and Human Services: Health Care Financing Administration

 

Explore the full database of GAO's Open Recommendations »

Oct 18, 2017

Oct 4, 2017

Oct 3, 2017

Sep 29, 2017

Sep 13, 2017

Sep 12, 2017

Sep 8, 2017

Sep 7, 2017

Looking for more? Browse all our products here