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B-164031(4) 1 (1970-02-11)

handle is hein.gao/gaobabksc0001 and id is 1 raw text is: JT WASHINGTON D C 20548 B)RELEASED B,0(FEB 1 11970 Dear Mr. Chairman: On September 3, 1969, the General Accounting Office transmitted to the Senate Committee on Finance its report on a review of Medicare payments made to The Associated Physicians of the Cook County Hospital (the Associa- tion) in Chicago, Illinois. That review was made in accordance with a request from the Committee dated April 28, 1969, and the matters discussed in the report were among the subjects covered in the Committee hearings in July 1969 at which representatives of our Office testified. During those hearings, officials of the Social Security Administration (Social Security) advised the Committee that they would seek recovery for any improper Medicare payments made to the Association by the Illinois Medical Service (Blue Shield) for the services of supervisory and teaching physicians. Subsequent to the hearings, Social Security, Blue Shield, and Association officials met several times and reviewed the 75 Medicare beneficiary cases discussed in our report. As a result of these actions, Social Security and Blue Shield concluded that, of the $10,727 paid to the Association in those 75 cases, only $2,593 should have been paid and that $8,134 had been overpaid. In December 1969, Social Security, by applying statistical methods to the 75 cases, projected the amount of the overpayment for all the cases for which payment had been made and estimated that, of the $1.6 million paid to the Association, the total overpayment could have been as much as $1,328,000. Recovery action, however, had not been completed at that time because the Association had not accepted the conclusion of Social Security officials that overpayments had been made. Social Security and Blue Shield officials held a meeting with officials of the Association on January 28, 1970, to further discuss the amount of the projected overpayment and arrangements for its repayment, however, no final agreements were reached. Because any future recovery could be made from monies held by the Association, on December 19, 1969, Mr. Jay D. Constantine, professional staff member of the Committee, requested us to report to the Committee on the financial position of the Association as of November 30, 1969. r~~

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