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093039 1 (1970-12-31)

handle is hein.gao/gaobacwxt0001 and id is 1 raw text is: O 30 DS .~ ..z~ C < ~*-~f--.p CIVIL DIVISION December 31, 1970 Dear Mr. Ball: The General Accounting Office has reviewed the procedures used by California Physicians' Service, San Francisco, California, for processing and paying claims for physicians' services under the Medicare program. California Physicians' Service is the carrier which makes payments for Medicare part B services provided to beneficiaries in 49 counties in the State of California. As part of our review, we examined a random sample of 160 claims processed and paid by the carrier for part B services during the 3-month period ending March 31, 1968, to determine if the carrier had made duplicate payments for the same service. b also examined 100 of the claims to evaluate the carrier's deter- mination that the services provided were covered by Medicare and that the charges-for the services were reasonable. The problems noted during our review were discussed with carrier and Social Security Administration (SSA) regional office officials. The problems noted and the corrective actions that have subsequently been taken by the carrier and SSA are discussed below. PROBLEMS NOTED DURING OUR REVEW Our review showed that the carrier had not instituted appro- priate claims processing quality control measures and did not have an adequate system to detect and prevent duplicate payments as required by SSA. Our review of the random sample of claims showed that the carrier: --made duplicate payments amounting to about $352 for 43 services on 10 claims; --paid about $830 for 141 services obtaining adequate evidence that were covered by Medicare or that services were reasonable, and --made errors in coding and recordi contributed to improper payments. on 28 claims without the services provided the charges for the ng chage data which UNITED STATES GENERAL ACCOUNTING OFFICE WASHINGTON, D.C. 20548

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