Review of excessive payments by TrailBlazer Health
Healthcare Auditing Weekly, OIG, May 13, 2008
Of the 382 payments of $10,000 or more that TrailBlazer Health Enterprises (TrailBlazer) made to providers in 2003, 270 were correct, according to an OIG report. TrailBlazer incorrectly paid providers for 103 of the remaining claims, resulting in total net overpayments of $236,523. On three claims totaling $46,903, providers were unable to locate records for the beneficiaries. The OIG could not ascertain whether five claims were paid correctly and did not review one claim because the provider had filed for bankruptcy.
The OIG advised TrailBlazer to:
- ensure that net overpayments totaling $236,523 have been recovered
- recover $46,903 for the three unsupported claims
- recover any overpayments related to system pricing errors
- review internal controls related to updating system pricing for procedure codes
- review internal controls related to manual processing and claim adjustment
- use the results of this audit in its education activities
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