Medicare

Millions in Potential Recoveries Not Being Sought by Maryland Contractor Gao ID: HRD-91-32 January 25, 1991

GAO evaluated the adequacy of the Health Care Financing Administration's (HCFA) Medicare contractor budget for claims processing and program safeguard activities, focusing on the Maryland Medicare claims processing contractor's: (1) payment of claims for which other health insurers may have had primary payment responsibility under the Medicare secondary payer (MSP) program; and (2) efforts and resources for pursuing MSP recoveries.

GAO found that: (1) the Maryland Medicare contractor paid at least $8.8 million in Medicare claims that primary insurers should have paid under MSP provisions; (2) 13 insurers were each potentially responsible for more than $100,000 of the health care payments, and the Maryland Medicare contractor, as a private primary health insurer, was potentially responsible for $4.1 million of the payments; (3) the contractor did not pursue the large inventory of potential recoveries due to reductions in funds for MSP activities, and had only 1.5 full-time-equivalent staff assigned to recover mistaken MSP payments; and (4) the contractor estimated that, with an additional $200,000 for needed staff, it could eliminate the total MSP backlog in 1 year.

Recommendations

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