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Department of Health and Human Services

Office of Inspector General -- AUDIT

"Audit of Medicare Part B Services Billed by Community Urgent Care Medical Group for the Period January 1, 1995 through July 31, 1999," (A-09-00-00089)

November 15, 2001


Complete Text of Report is available in PDF format (1.98 MB). Copies can also be obtained by contacting the Office of Public Affairs at 202-619-1343.


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.