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Medicare: Over $1 Billion Should Be Recovered From Primary Health Insurers

HRD-92-52 Published: Feb 21, 1992. Publicly Released: Feb 21, 1992.
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Highlights

Pursuant to a congressional request, GAO reviewed Medicare contractors' efforts to administer Medicare Secondary Payer (MSP) program provisions intended to ensure that primary insurers pay claims before Medicare.

Recommendations

Recommendations for Executive Action

Agency Affected Recommendation Status
Department of Health and Human Services The Secretary of Health and Human Services should direct the Administrator, HCFA, to initiate a request to the Office of Management and Budget (OMB) to release the necessary contingency funds for use in recovering mistaken payments owed to Medicare.
Closed – Implemented
OMB released $19.9 million to Medicare contractors for recovering amounts owed Medicare by private insurers. Backlogs of about $1 billion existed. Medicare contractors had reduced these backlogs to about $136 million as of March 31, 1993. As a result of GAO's work and Medicare contractors' efforts, about $278 million was recovered from primary health insurers.

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Topics

Health Care
Data collectionErroneous paymentsGovernment collectionsHealth insurance cost controlInsurance claimsMedical expense claimsMedicareQuestionable paymentsReimbursements to governmentMedicare payments