Department of Health
Medicaid Payments for HIV Pre-test Counseling Services (Follow-Up Report) Medical service providers may be reimbursed by Medicaid for counseling services provided to Medicaid recipients prior to their testing for HIV, even if the recipients decline the testing. However, to be eligible for such reimbursements, the providers must comply with certain Medicaid regulations.
In audit report 2006-S-34, we examined the Medicaid payments for such counseling services over a five-year period to determine whether the payments were made in accordance with the regulations. We identified as much as $4.2 million in potential overpayments for the counseling services. The overpayments were made because the State’s system for processing Medicaid claims was not designed to detect such potential overpayments. We noted that most (about $3 million) of the potential overpayments were made to two downstate clinics. We recommended that the payments be investigated and all overpayments recovered. We also recommended that claims processing controls be strengthened to prevent such overpayments in the future. When we followed up on these matters with officials at the Department of Health, we found that our recommendations had been implemented.
For a complete copy of Report 2007-F-20 click here.
For a copy of the 90-day response click here.