Department of Health

Medicaid Payments to Clinics When the Patients Were Hospitalized (Follow-Up Report)

Medicaid reimbursement rates for inpatient hospital care are generally intended to cover all the costs associated with a hospital stay, including the cost of any services provided by a clinic or emergency room either during hospitalization or on the day a patient is hospitalized. However, in our prior audit 2006-S-51, we determined that as much as $25.7 million in Medicaid payments were inappropriately made for services provided by clinics or emergency rooms to hospitalized patients either during the patientís hospital stay or on the day the patient was hospitalized. We recommended that the payments be investigated and all overpayments recovered, and certain automated claims processing controls be strengthened. When we followed up on these matters, we found that Department of Health officials had made progress in implementing our audit recommendations.

For a complete copy of Report 2008-F-10 click here.
For a copy of the 90-day response click here.