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EXECUTIVE SUMMARY:
The objective of our audit was to examine the Medicare Part B payments for services billed by Community Urgent Care Medical Group (Community) for the period January 1, 1995 through July 31, 1999 to determine if the payments (about $3.7 million) were appropriate. Our review disclosed that 29 services in our random, statistical sample of 100 claims (135 services) were overpaid. The 29 overpaid services included 23 which had been upcoded, 3 for which the documentation did not support the services billed, and 3 for which the documentation did not support that a teaching physician was present when a resident performed the service. Based upon our random sample, we estimate that Community received $266,236 in Medicare overpayments during the audit period. We are recommending that Community refund the identified overpayment.