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Brought to you by the Council of the Inspectors General on Integrity and Efficiency
Federal Reports
Report Date
Agency Reviewed / Investigated
Report Title
Type
Location
Department of Health & Human Services
TrailBlazer Health Enterprises, LLC, Claimed Some Unallowable Medicare Pension Costs for Fiscal Years 2003 and 2004
TrailBlazer Health Enterprises, LLC, a subsidiary of Blue Cross Blue Shield South Carolina, claimed unallowable pension costs of $341,000 for Medicare reimbursement for fiscal years 2003 and 2004.
Improper payments to healthcare providers constitute a significant vulnerability for Medicaid, costing an estimated $17.5 billion in fiscal year 2014. Automated claims processing safeguards called "edits" are critical program integrity tools that are available to State Medicaid agencies to prevent these improper payments. The Affordable Care Act required all States to implement the Medicaid National Correct Coding Initiative (NCCI) edits by October 1, 2010. The NCCI edits are designed to encourage providers to code correctly by automatically denying fee-for-service Medicaid payments for services that do not meet basic medical or billing standards.
