Department of Health
Office of Temporary and Disability Assistance

Medicaid Claims Processing Accuracy, Year Ended March 31, 1996 (Follow-Up Review)

The Medicaid Management Information System (MMIS) is a centralized, automated medical assistance information and payment system that is operated by a fiscal agent under a contract with the Department of Health (the contract was previously administered by the Office of Temporary and Disability Assistance). We conduct continuous audits of the MMIS, including weekly examinations of the accuracy of the Medicaid claims that are processed. In our prior report 95-D-7 it was noted that, during the year ended March 31, 1996, the weekly examinations determined that health care providers were overpaid as much as $11.2 million in Medicaid, primarily because third-party insurance coverage had not been fully taken into account by the providers. We recommended that the potential overpayments be investigated and actual overpayments be recovered. In our follow-up review, we found that progress has been made in investigating and recovering overpayments, but some potential overpayments have yet to be investigated and some actual overpayments have yet to be recovered.

For a complete copy of Report 97-F-33 click here.