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Report File
Date Issued
Submitting OIG
Department of Health & Human Services OIG
Other Participating OIGs
Department of Health & Human Services OIG
Agencies Reviewed/Investigated
Department of Health & Human Services
Components
Centers for Medicare and Medicaid Services
Report Number
A-06-21-05003
Report Type
Audit
Number of Recommendations
6
Questioned Costs
$1,188,759
Funds for Better Use
$0

Open Recommendations

This report has 3 open recommendations.
Recommendation Number Significant Recommendation Recommended Questioned Costs Recommended Funds for Better Use Additional Details
22-A-06-098.01 No $414,860 $0

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 No $773,899 $0

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 No $0 $0

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.

Department of Health & Human Services OIG

United States