OIG Home  Reports  Office of Audit Services  Center For Medicare and Medicaid Services 

Audit (A-05-08-00022)

04-24-2009
Review of High-Dollar Payments for Services Processed by Wisconsin Physicians Service for the Period January 1, 2004, Through December 31, 2006

Executive Summary

Of the 100 sampled high-dollar payments that Wisconsin Physicians Service (WPS) made to Medicare Part B providers for services provided during calendar years (CY) 2004 through 2006, 77 were appropriate. The 23 remaining payments included net overpayments totaling $118,000, of which $96,000 for 20 payments had not been refunded at the start of our audit. Based on the sample results for our 3-year audit period, we estimated that WPS made 402 overpayments totaling $2.06 million to providers in Illinois, Michigan, Minnesota, and Wisconsin for Part B services.

We recommended that WPS (1) recover the $96,000 in identified overpayments, (2) review the 1,647 remaining high-dollar payments with potential overpayments estimated at $1.9 million ($2.06 million less $118,000 overpaid) and work with the providers that claimed these services to recover any overpayments, (3) consider reviewing high-dollar payments made for services provided after CY 2006 and recover any additional overpayments, and (4) improve internal controls related to manual claim processing. In written comments on our draft report, WPS described corrective actions that it had taken or planned to take to implement our recommendations.

Complete Report

Download the complete report (PDF)
Adobe Acrobat Reader is required to view PDF files.

Copies can also be obtained by contacting the Office of Public Affairs at 202-619-1343.