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HRD-82-67 1 (1982-04-30)

handle is hein.gao/gaobabdfg0001 and id is 1 raw text is: UNITED STATES GENERAL ACCOUNTING OFFICE WASHINGTON, D.C. 2054 PUMAN RMIrnCORCS ,oivssio April 30, 1982 B-207260 The Honorable Richard S. Schweiker11 IIlH II I The Secretary of Health and Human 118307 Services Dear Mr. Secretary: Subjects 1$eed to Recover Medicare Part B Duplicate Payments in Illinois (GAO/HRD-82-67) In our December 1, 1981, report, 1/ we recommended that you direct the Health Care Financing Administration (HCFA) to analyze the large amount of Medicare part B overpayments in Illinois de- tected through the quality assurance program--estimated to be about $27.7 million from April 1979 through June 30, 1981--because we believed that such an analysis might identify patterns to these overpayments and assist in the recovery of some of this money. The Department agreed with our recommendation. As part of our review of Medicare contracting, we developed a computer program which identified a substantial number of actual and potential duplicate payments made by the Illinois carrier-- Electronic Data Systems Federal Corporation (EDSF). This report summarizes the results of this effort, which was not complete at the time we issued our December 1981 report and testified on Decem- ber 3, 1981, before the Subcommittee on Health, Senate Committee on Finance. Specifically, 57 percent (284- of 499) of the line items 2/ we reviewed represented duplicate payments with allowed amounts 3/ totaling about $21,000. We also identified more than 24,000 potential duplicate line-item payments with allowed amounts I/Experiments Have Not Demonstrated Success of Competitive Fixed-Price Contracting in Medicare (HRD-82-17). 2/A line item is a service or series of services for the same beneficiary having the same medical or surgical procedure code. 3/Allowed amount is the amount on which Medicare payments are computed. Generally, Medicare pays 80 percent of the allowed amount. (106211) 4 ~{ 96K'

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