Department of Health

Medicaid Payments for HIV Pre-test Counseling Services

Medical service providers may be reimbursed by Medicaid for counseling services provided to Medicaid recipients prior to their testing for HIV, even if the recipients decline the testing. However, to be eligible for such reimbursements, the providers must comply with certain Medicaid regulations (e.g., recipients may receive more than two counseling session a year only in certain specific circumstances, which must be documented by the provider). We examined the Medicaid payments for such services over a five-year period to determine whether the payments were made in accordance with the regulations. We identified as much as $4.2 million in potential overpayments for these services. The overpayments were made because the State’s system for processing Medicaid claims was not designed to detect such potential overpayments. We noted that most (about $3 million) of the potential overpayments were made to two downstate clinics. We recommended that the payments be investigated and all overpayments recovered. We also recommended that claims processing controls be strengthened to prevent such overpayments in the future.

For a complete copy of Report 2006-S-34 click here.
For a copy of the 90-day response click here.
For a copy of the associated follow-up report click here.