Skip to Highlights
Highlights

Pursuant to a congressional request, GAO reviewed Medicare contractors' claims-processing activities, to identify: (1) Medicare payments mistakenly made to hospitals for inpatient services that resulted in credit balances due Medicare; (2) the reasons for such payments; (3) hospital efforts to refund credit balances; and (4) Medicare contractor actions to recover amounts owed to the program.

Skip to Recommendations

Recommendations

Recommendations for Executive Action

Agency Affected Recommendation Status
Department of Health and Human Services 1. The Secretary of Health and Human Services should take the necessary steps to ensure that HCFA monitors intermediaries' compliance with recent credit balance instructions.
Closed - Implemented
HCFA has required Medicare contractors to assign the responsibility for credit balance recoveries to a specific unit or person. HCFA plans to monitor contractor compliance with credit balance instructions. Additional guidance was provided to Medicare contractors and providers in June 1992 concerning the recovery of outstanding credit balances.
Department of Health and Human Services 2. The Secretary of Health and Human Services should take the necessary steps to ensure that HCFA requires intermediaries to: (1) identify the causes of Medicare credit balances and, where appropriate, initiate corrective actions; and (2) ensure that hospitals identify and make accurate refunds of all amounts owed to Medicare.
Closed - Implemented
OMB approved a request that requires Medicare providers to submit quarterly reports on credit balances. As of March 1994, hospitals and other providers had reported about $494 million in mistaken payments, of which $651 million, or 93 percent, had been recovered.

Full Report