Department of Health
Department of Social Services

Medicaid Payments to Clinics Using Products of Ambulatory Surgery and Ambulatory Care Methodology (Follow-Up Review)

Under the Medicaid program, hospital-based clinics may be reimbursed for providing patients with preventive, diagnostic, rehabilitative or other types of services termed ambulatory care and ambulatory surgery. The reimbursements, which were processed by the Department of Social Services at the time of our prior audit, should be based on rates established by the Department of Health. In our prior audit report 94-S-84, we examined these reimbursements over a 29-month period and found that clinics were overpaid as much as $4.5 million because services were billed at incorrect rates, the same service was billed more than once, and the prior approval of the Department of Health was not documented for certain types of services. We recommended that the overpayments be recovered and controls be established to detect such billing errors. In our follow-up review, we found that these recommendations have been fully implemented.

For a complete copy of Report 97-F-11 click here.