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Audit (A-04-08-00043)

11-10-2008
Review of High-Dollar Part B Claims Processed by CIGNA Government Services Carrier No. 05535 for the Period January 1, 2004, Through December 31, 2006

Executive Summary

During calendar years (CY) 2004-2006, CIGNA Government Services Carrier No. 05535 (the contractor) overpaid providers in North Carolina $156,000. Generally, the contractor made the overpayments because the providers incorrectly billed excessive units of service. In addition, the Medicare claim processing systems did not have sufficient edits in place during CYs 2004-2006 to detect and prevent payments for these types of erroneous claims. We recommended that the contractor recover the identified overpayments. In written comments on the draft report, CIGNA Government Services stated that it had adjusted these 17 claims and was pursuing the associated overpayments.

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