Department of Health

Nursing Home Claims Paid for Medicare Eligible Recipients

Medicare is a federal health insurance program for the aged and the disabled; Medicaid is a joint state and federal health insurance program for the needy. If an individual is eligible for both Medicare and Medicaid, the individualís eligible medical costs are generally paid by Medicare. We examined the nursing home claims paid by Medicaid over a three-year period on behalf of individuals who were eligible for both Medicaid and Medicare. We determined that at least $7.0 million in Medicaid may have been overpaid, because the nursing homes had not billed Medicare or had billed, and received duplicate payments from, both Medicare and Medicaid. We recommended that the Medicaid overpayments be investigated and recovered.

For a complete copy of Report 2003-S-32 click here.
For a copy of the 90-day response click here.