Audit Of The Railroad Medicare Benefit Integrity Program At Palmetto Government Benefits Administrators

OFFICE OF INSPECTOR GENERAL Audit Report Audit of the Railroad Medicare Integrity Program at Palmetto Government Benefits Administrators Report No. 09-04 September 25, 2009 RAILROAD RETIREMENT BOARD TABLE OF CONTENTS Introduction Background .......................................................................................................1 Audit Objective ..................................................................................................3 Scope ................................................................................................................3 Methodology......................................................................................................3 Results of Audit Proactive Fraud Investigations and Data Analysis Are Limited .........................6 Additional Budget and Accounting Detail Is Needed .........................................7 CERT Methodology Would Strengthen Improper Payment Estimates ..............8 Identification of Excluded Providers is Not Fully Effective ...............................11 Excluded Provider Investigations Could Identify Improper Payments .............12 High Dollar Transactions Should Be Referred for Investigation.......................13 Investment in Fraud Training is Needed..........................................................14 Benefit Integrity Procedures Can Be Improved .......................................... ...