Review of Medicare Payments Exceeding Charges for Outpatient Services Processed by National Government Services in Jurisdiction 15 for the Period January 1, 2006, Through June 30, 2009

摘要

During our audit period (January 1, 2006, through June 30, 2009), National Government Services was the Medicare contractor for Jurisdiction 15 in Ohio and Kentucky. For Jurisdiction 15, National Government Services processed approximately 195 million line items for outpatient services during the audit period, of which 1,290 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.) 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.