Department of Social Services
Department of Health

Impact of Third-Party Insurance Coverage on Medicaid Payments (Follow-Up Review)

Medicaid may be used to pay for medical services only when the patients treated have no other health insurance coverage. In our prior audit report 94-S-72, we examined the procedures used by the Department of Social Services to ensure that Medicaid payments were not made on behalf of patients with private insurance coverage. Our examination of selected Medicaid payments over a four-year period found that hospitals may have been overpaid as much as $43.4 million because they did not bill available private insurers or did not accurately report the revenue received from these insurers. We recommended that the overpayments be recovered and procedures be improved to prevent such overpayments in the future. In our follow-up review, we found that these recommendations have been fully implemented.

For a complete copy of Report 97-F-10 click here.
For a copy of the 90-day response click here.