Department of Health

Oversight of Medicaid Third-Party Recovery Activities

The Department of Health pays Medicaid claims submitted by service providers. If it is determined that some or all of a claim should have been paid by a third-party insurer, the Department seeks to recover this amount from the third-party insurer. To facilitate third-party recoveries, the Department contracts with private firms, which are paid fees based on the amounts recovered. We audited the Departmentís oversight of one such firm and found that the oversight was, for the most part, sufficient to ensure the accuracy of recoveries accounting for about 95 percent of the fee payments made to the firm. However, substantial improvements were needed in the oversight of a certain type of recovery that accounted for the remaining fees. We recommended actions that could be taken to improve this oversight.

For a complete copy of Report 2004-S-16 click here.
For a copy of the 90-day response click here.