Department of Health

Inappropriate Medicaid Claims for Newborn Services

Newborn infants with low birth weights require higher levels of care. Accordingly, the Medicaid reimbursement rates for such infants are higher than the rates for infants with normal birth weights. We audited selected Medicaid payments for services provided to newborn infants and identified overpayments of $480,894. The overpayments were made because the claims submitted by the medical providers erroneously understated the infants’ birth weights. We recommended the Department of Health recover the overpayments and develop controls to identify and prevent such overpayments in the future.

For a complete copy of Report 2008-S-152 click here.
For a copy of the 90-day response click here.
For a copy of the associated follow-up report click here.