Medicare: Millions in Potential Recoveries Not Being Sought by Maryland Contractor
HRD-91-32
Published: Jan 25, 1991. Publicly Released: Jan 25, 1991.
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Highlights
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.
Recommendations
Recommendations for Executive Action
Agency Affected | Recommendation | Status |
---|---|---|
Health Care Financing Administration | 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. |
Closed – Implemented
The Medicare contractor has recouped $6.2 million in overpayments.
|
Health Care Financing Administration | The Administrator, HCFA, should closely monitor the Medicare contractor's performance in meeting the milestones set for the recovery activity. |
Closed – Implemented
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.
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Topics
Billing proceduresClaims processingContract performanceErroneous paymentsHealth insurance cost controlInsurance claimsMedical expense claimsMedicareQuestionable paymentsRefunds to government