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EXECUTIVE SUMMARY:
The objective of this review was to determine whether Pinnacle Business Solutions, Inc.’s (Pinnacle), high-dollar Medicare payments to New Mexico Part B providers were appropriate. Eleven of the 16 high-dollar payments that Pinnacle made to providers were appropriate. However, Pinnacle overpaid providers $39,539 for the remaining five payments. A provider refunded one overpayment of $1,048 prior to our fieldwork. Four overpayments totaling $38,491 remained outstanding. We recommended that Pinnacle recover the $38,491 overpayment and consider using the results of this audit in its provider education activities. Pinnacle agreed with the findings and recommendations.