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OIG Recommends Recovery of More Than $4 Million in Overpayments

April 14, 2009:

The Office of Inspector General (OIG) has released a report indicating that after a review of high-dollar payments for inpatient services processed by National Government Services in Illinois, Indiana, Kentucky, and Ohio for calendar years 2004 through 2006, only 39 of the 303 services were paid correctly. This audit was performed as part of a nationwide review of payments for inpatient services of $200,000 or more (high-dollar payments).

The remaining 264 payments included net overpayments totaling $7.4 million. At the start of the audit, hospitals had refunded overpayments totaling $2.8 million for four claims but had not refunded net overpayments totaling $4.7 million for 260 claims.

The OIG has recommended that National Government Services:

  • Recover the $4.7 million in identified net overpayments.
  • Use the results of this audit in its provider education activities related to data entry procedures and proper documentation.
  • Consider implementing controls to identify and review all payments greater than $200,000 for inpatient services.

In its written comments, National Government Services agreed with the OIG’s recommendations.

It appears that the overpayments were the result of the facilities inaccurately reporting the number of billing units for blood clotting factor, reporting incorrect diagnosis and procedure codes, and reporting excessive charges that resulted in inappropriate outlier payments. Hospitals attributed most of the incorrect claims to data entry errors and insufficient documentation. National Government Services made these incorrect payments because neither the Fiscal Intermediary Standard System nor the Common Working File had sufficient edits in place to detect and prevent the overpayments.

Deborah C. Hall
New Product Subject Matter Expert


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