Providers were overpaid by nearly $7 million between 2006 and 2009, according to the audit results released Aug. 17 from the Office of the Inspector General for the Medicare Administrative Contractor (MAC) Highmark.
The OIG found that 68% of 1,507 selected claims processed by Highmark, the MAC for Pennsylvania, Delaware, Maryland, New Jersey and the District of Columbia metro area were incorrectly paid for outpatient services between Jan. 1, 2006 and June 30, 2009.
Providers had not refunded any of the overpaid funds by the start of the OIG’s investigation, according to the report.
Other problems with Highmark claims included:
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Incorrect units of service;
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Packaged services billed separately;
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Healthcare Common Procedure Coding System (HCPCS) codes that did not reflect the procedures performed;
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Unallowable services;
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Unlabeled use of a drug/biological;
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A lack of supporting documentation;
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A combination of incorrect units of service and incorrect HCPCS codes; and
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Incorrectly calculated payments.
OIG recommends that Highmark recover the millions of dollars in overpaid claims and install system edits that preclude line item payments that exceed billed charges by a prescribed amount, the report says.