Medicare-Medicaid Audit World
On July 18, 2012 the HHS Inspector General released an audit entitled Review of Medicare Payments Exceeding Charges For Outpatient Services Processed by Wisconsin Physicians Service Insurance Corporation in Jurisdiction 5 For The Period January 1 2006 Through June 30, 2009. The audit analyzed 2,197 line items on claims for outpatient services paid by Wisconsin Physicians Service (WPS) in which the amount paid by Medicare was more than $1,000 greater than the provider’s bill and in which the line item billed for more than 3 units of service. The audit found, among other things, that incorrect units of service were reported on 1,182 line items resulting in overpayments to the providers of at least $4,411,569.
Examples cited by the OIG include one provider who billed Medicare for an incorrect number of service units on 114 line items in which the provider billed between 640 and 656 service units rather than the correct 32 service units. As a result of these errors, WPS paid the provider $219,518 when it should have paid $10,097, an overpayment of $209,421.
Another provider billed Medicare for an incorrect number of service units on 72 line items. Rather than billing between 1 and 3 service units, the provider billed between 42 and 45 service units. WPS paid the provider $178,308 when it should have paid $7,941, an overpayment of $170,367.
When questioned by the OIG about the errors, the providers attributed the incorrect payments to clerical errors or to billing systems that could not prevent or detect the incorrect billing of units of service and other types of billing errors.