Department of Health
Potential Overpayments of Medicaid Provider Claims for Human Immunodeficiency Virus (HIV) Primary Care Services (Follow-Up Report) Medicaid provides an annual evaluation, periodic testing and monitoring services (primary care services) to recipients with the Human Immunodeficiency Virus (HIV). These services are subject to certain frequency limits. In audit 2008-S-5, we examined the Medicaid claims submitted by clinics over a three-year period for HIV primary care services and identified a number of instances in which these frequency limits appeared to have been exceeded. For example, in 2006, a clinic billed Medicaid for 12 annual evaluations for the same recipient. We identified a total of about $2.4 million in potential overpayments to 174 such clinics. We recommended that the Department of Health investigate the potential overpayments, recover all actual overpayments, and develop controls to prevent such overpayments in the future. When we followed up on this matter with Department officials, we found that they had made some progress in their implementation of our audit recommendations.
For a complete copy of Report 2009-F-40 click here.