HHS/OIG, Audit - "Review of High-Dollar Payments for New Mexico Medicare Part B Claims Processed by Pinnacle Business Solutions, Inc., for the Period January 1, 2003, Through December 31, 2003," (A-06-07-00087)

Department of Health and Human Services

Office of Inspector General -- AUDIT

"Review of High-Dollar Payments for New Mexico Medicare Part B Claims Processed by Pinnacle Business Solutions, Inc., for the Period January 1, 2003, Through December 31, 2003," (A-06-07-00087)

December 28, 2007

Complete Text of Report is available in PDF format (266 kb). Copies can also be obtained by contacting the Office of Public Affairs at 202-619-1343.

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.