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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