Department of Health

Selected Medicaid Payments for Medicare Part B Eligible Recipients

If an individual is eligible for both Medicare and Medicaid, the individual's eligible medical costs are to be paid by Medicare, except for a portion of the costs relating to certain services (called Part B services), which are to be paid by Medicaid. We examined selected payments made by Medicaid in 1998 on behalf of individuals who were eligible for both Medicare and Medicaid. We determined that as much as $18.6 million in Medicaid may have been overpaid, mainly because some of the bills submitted to Medicaid did not accurately report certain information relating to the patientsí Medicare coverage. We also determined that managed care providers were overpaid, because contrary to their contracts with the Department, some of the individuals enrolled in their Medicaid managed care programs were eligible for Medicare. Since the health care costs of such individuals are generally covered by Medicare, it is not cost-effective for them to be enrolled in Medicaid managed care programs. We recommended that the overpayments be investigated and recovered, and procedures be established for preventing such payments in the future.

For a complete copy of Report 2000-D-3 click here.
For a copy of the 90-day response click here.
For a copy of the associated follow-up report click here.