OIG audit finds overpayment by Medicaid intermediary
Healthcare Auditing Weekly, September 11, 2007
A high-dollar Medicaid payment made by Chisholm Administrative Services (Chisholm), a Medicare Part A intermediary serving Medicare providers in Oklahoma, was not appropriate, according to a recent OIG audit.
In 2005, Chisholm made one payment for more than $50,000 for outpatient services. The OIG determined the payment was incorrect and requested that the provider review the claim. The provider submitted a new claim and refunded $57,700 to the government.
The OIG determined Chisholm made this overpayment because neither the Fiscal Intermediary Standard System nor the Common Working File had sufficient edits in place in calendar year 2005 to detect billing errors related to units of service.
The OIG also recommended Chisholm review the provider's payment history for claims under $50,000 that bill code C9205 and correct any claims found in error and use the results of this audit in its provider education activities.
Click here to read the full audit report.
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