Department of Health

Medicaid Clinic and Emergency Room Claims Paid During a Recipient's Hospital Stay

Medicaid reimbursement rates for inpatient hospital care are intended to cover all the costs associated with a hospital stay, including the cost of any services provided by a clinic or emergency room either during hospitalization or on the day a patient is hospitalized. However, we identified many instances in which Medicaid payments were made for services provided by clinics or emergency rooms either during a patient's hospital stay or on the day the patient was hospitalized. During the 57 months covered by our audit, we identified as much as $16.9 million in such payments. We recommend that these payments be investigated, all overpayments be recovered, and controls be improved to prevent such overpayments in the future. We also found that, while other overpayments of this kind had been identified by Department auditors, the Department was slow to recover many of the overpayments. We recommend that such overpayments be recovered promptly.

For a complete copy of Report 98-S-10 click here.
For a copy of the 90-day response click here.
For a copy of the associated follow-up report click here.