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Where To Report Waste
Fraud, Abuse, Or Retaliation
Where To Report Waste Fraud, Abuse, Or Retaliation

Medicare Part B Overpaid and Beneficiaries Incurred Cost-Share Overcharges of Over $1 Million for the Same Professional Services

Submitting OIG: 
Department of Health & Human Services OIG
Date Issued: 
Monday, September 19, 2022
Agency Reviewed / Investigated: 
Department of Health & Human Services
Submitting OIG-Specific Report Number: 
A-06-21-05003
Component, if applicable: 
Centers for Medicare & Medicaid Services
Centers for Medicare and Medicaid Services
Location(s): 
United States
Type of Report: 
Audit
Questioned Costs: 
$1,188,759
Funds for Better Use: 
$0
Number of Recommendations: 
6
View Document: 
AttachmentSize
PDF icon 62105003.pdf1.88 MB

Related Open Recommendations

Recommendation Number Recommendation Status Significant Recommendation Additional Details
22-A-06-098.01 Open No
We recommend that the Centers for Medicare & Medicaid Services: direct the MACs to recover the $331,448 from the CAHs for 12,156 claims for which the health care practitioners had not reassigned their billing rights to the CAHs and $83,412 in cost-sharing overcharges to Medicare beneficiaries that are within the 4-year reopening period;
22-A-06-098.02 Open No
We recommend that the Centers for Medicare & Medicaid Services direct the MACs to recover the $575,990 from the health care practitioners for 7,857 claims for which health care practitioners had reassigned their billing rights to the CAHs and $197,909 in cost-sharing overcharges to Medicare beneficiaries that are within the 4-year reopening period.
22-A-06-098.04 Open No
We recommend that the Centers for Medicare & Medicaid Services coordinate with the MACs to develop and implement claim system edits or alternative means to prevent and detect overpayments for professional service payments.
Displaying 3 of 3 Recommendations