Medicare Secondary Payer Program:

Identifying Beneficiaries with Other Insurance Coverage Is Difficult

T-HRD-93-13: Published: Apr 2, 1993. Publicly Released: Apr 2, 1993.

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GAO discussed the Medicare secondary payer (MSP) program. GAO noted that: (1) 4 percent of Medicare beneficiaries have other primary health insurance; (2) the Health Care Financing Administration (HCFA) saved $2.8 billion when providers properly billed other insurers rather than Medicare; (3) backlogs of mistakenly paid claims have exceeded $1 billion over the past several years; (4) a data match using records from several federal agencies has helped HCFA identify over 1 million additional beneficiaries who potentially have other health insurance; (5) recent HCFA initiatives have enhanced contractors' ability to identify primary payers and avoid erroneous payments, but identification efforts are costly and dependent on accurate information; (6) HCFA current and planned MSP activities include requiring part A providers to interview beneficiaries about other insurance coverage at the time services are provided, researching beneficiaries' claims to see if they were working and had private insurance, and providing contractors with detailed information about beneficiaries' insurance coverage at the time they enroll in Medicare; (7) contractors have lacked the resources to identify and recover erroneous payments; (8) time limitations may hamper recovery of a significant portion of the contractor payments; and (9) MSP screening activities may be hampered by a conflict of interest when contractors are the primary payers for claims subject to MSP provisions.

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