Department of Health

Medicaid Payments for Medicare Part A Beneficiaries

If an individual is covered by both Medicare and Medicaid, Medicare is the primary payer. Medicaid is the payer of last resort and generally pays a small portion of costs. Most people become eligible for Medicare Part A health insurance when they turn 65. We examined whether Medicaid made overpayments for those who were also eligible for Medicare Part A health insurance. We found that the Department of Health’s Medicaid claims and payment processing system did not always identify Medicaid recipients who were also covered by Medicare Part A. As a result, we identified $14 million in potential Medicaid overpayments for the two years ended December 31, 2007. We also found that Medicaid processed claims totaling about $20 million for inpatient hospital services for which Medicare Part A was never billed. Our report recommended the Department take certain actions to addresses these matters.

For a complete copy of Report 2009-S-36 click here.