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Proposal To Improve Identification and Collection of Medicare Part B Duplicate Payments

HRD-84-88 Published: Aug 17, 1984. Publicly Released: Aug 17, 1984.
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Highlights

GAO reviewed the operations of selected Medicare claims processing contractors to determine whether it would be cost beneficial for the carriers to periodically screen their claims on a postpayment basis to recover duplicate payments.

Recommendations

Recommendations for Executive Action

Agency Affected Recommendation Status
Health Care Financing Administration The Administrator of the Health Care Financing Administration (HCFA) should require Maryland Blue Shield to follow up on the 6,130 potential duplicates GAO identified.
Closed – Implemented
Maryland Blue Shield collected an unknown amount on 36 claims. Additional collection action was not taken because HCFA stated that $5 saved for every $1 spent on collection efforts would not be achieved. The 5-to-1 ratio is the HCFA established level for cost saving initiatives.
Health Care Financing Administration The Administrator, HCFA, should require carriers to screen their paid claims computer records at least once a year and to recover the duplicate payments they identify.
Closed – Implemented
HCFA has narrowly defined cost-effective screens as those which produce 5-to-1 ratios of savings over costs. Because of this, GAO believes that opportunities are being missed by not allowing screens with positive but lower savings-to-cost ratios.
Health Care Financing Administration The Administrator, HCFA, should monitor the results achieved by the carriers so that the screening criteria: (1) can be modified as necessary; and (2) can be discontinued for any carriers that reduce their duplicate payments enough that screening paid claims is no longer cost beneficial.
Closed – Not Implemented
Because HCFA narrowly defined what constitutes a cost-effective screen, the carrier program was determined as ineffective. Therefore, HCFA has elected not to perform the monitoring GAO recommended.

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Topics

Claims processingMedicareContractorsCost controlDebt collectionHealth care servicesOverpaymentsElectronic data processingHealth care financeUtilization review