Department of Health

Medicaid Claims Paid for Medicare Part A Eligible Recipients (Follow-up Review)

We have reviewed the actions taken by the Department of Health (Health) to implement the recommendations contained in three prior audits concerning Medicaid Claims Paid for Medicare Part A Eligible Recipients for the years 1995, 1996 and 1997. Health is responsible for administering the Medicaid program. According to Federal law and State regulations, if a Medicaid recipient has health insurance from Medicare or other third-party resources, the medical service provider must bill Medicare and all third-party resources before billing Medicaid. In three previous audits, we identified about $33 million of potential Medicaid overpayments that Health needed to investigate and, where appropriate, recover. In this follow-up review, we found that Health officials made significant progress in recovering the overpayments that we identified in the three prior audits. Health officials had recovered about $22 million of the $33 million in overpayments, had concluded that about $5.8 million was correctly billed based on providers' explanations, and were pursuing recovery of the remaining $5.2 million.

For a complete copy of Report 2000-F-10 click here.