Review of Medicare Payments Exceeding Charges for Outpatient Services Processed by National Government Services in Jurisdiction 8 for the Period January 1, 2006 Through June 30, 2009

摘要

National Government Services is the Medicare contractor for most providers in Jurisdiction 8 in Indiana and Michigan. During our audit period (January 1, 2006, through June 30, 2009), approximately 217.6 million line items for outpatient services were processed in Jurisdiction 8, of which 1,409 line items had (1) a Medicare line payment amount that exceeded the line billed charge amount by at least $1,000 and (2) 3 or more units of service. (A single Medicare claim from a provider typically includes more than one line item. In this audit, we did not review entire claims; rather, we reviewed specific line items within the claims that met these two criteria. Because the terms payments and charges are generally applied to claims, we will use line payment amounts and line billed charges). We did not review two line items associated with two providers that were in bankruptcy. Our objective was to determine whether certain Medicare payments in excess of charges that National Government Services made to providers for outpatient services were correct.