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092615 1 (1971-06-28)

handle is hein.gao/gaobacwmk0001 and id is 1 raw text is: VL) S1- UNITED STATES GENERAL ACCouNTING OFFICE WASHINGTON,'D C 2054: CIVIL DIVISION June 28, 1971 Dear Mr. Ball: During a recent survey of Medicare payments involving hospital-based physicians in Illinois, we noted a situation where one hospital received, and two others may have received, excessive part B reinibursements or windfalls which were not adjusted by the intermediary. 1k are bringing this matter to your attention so that appropriate adjustments may be made for the three hospitals. Although we believe that the situation being questioned by us is covered under existing Vedicare reimbursement regula- tions, we are also bringing this matter to your attention so that this type of situation may be considered in connection with the instructions--which we understand the Social Security Administration is developing--to provide for the retroactive adjustment of amounts incorrectly reimbursed to hospitals and other providers for the charges of provider-based physicians under the supplementary medical insurance (1art B) portion of Medicare. The excessive reimbursements involved a situation where the hospital-based physician, using the hospital as his billing agent, billed the part B carrier for his services to Medicare patients at the hospital and had a lease agreement with the hospital whereby the hospital retained a fixed percentage of the total charges to cover certain indirect operaing costs; the portion of the physician's charges retained by the hospital exceeded the hospitalta related costs. The intermediary did not take such revenues and costs into account when making final settlements with the hospital for the cost of services under the hospital insurance (part A) portion of the Medicare program. 50TH ANNIVERSARY 1921 - 1971

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