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.
Recommendations for Executive Action
|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.|
|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.|