Medicare

Internal Controls Over Electronic Claims for Anesthesia Services Are Inadequate Gao ID: HRD-90-49 December 18, 1989

Pursuant to a legislative requirement, GAO reviewed Medicare payments to anesthesiologists and verified the anesthesia times claimed.

GAO found that: (1) all eight Medicare carriers GAO reviewed required anesthesia times on all paper claims for anesthesia services and did not process paper claims until providers submitted such times, but seven of the eight carriers paid electronic claims for services that did not show anesthesia times; (2) carriers lacked adequate assurance that providers billing electronically had correctly computed their anesthesia time units, and did not reconcile time units claimed with anesthesia times reported on the claims, sometimes resulting in overpayments; (3) the Health Care Financing Administration (HCFA) did not ensure that organizations adopted internal controls over the use of federal funds; and (4) HCFA annual contractor evaluations did not determine whether carriers subjected electronic claims to the same prepayment reviews as paper claims.

Recommendations

Our recommendations from this work are listed below with a Contact for more information. Status will change from "In process" to "Open," "Closed - implemented," or "Closed - not implemented" based on our follow up work.

Director: Team: Phone:


The Justia Government Accountability Office site republishes public reports retrieved from the U.S. GAO These reports should not be considered official, and do not necessarily reflect the views of Justia.