Department of Health
Medicaid Payments to Referred Ambulatory and Laboratory Providers While Recipients Were Hospitalized The daily Medicaid reimbursement rates for hospitalization generally cover the costs of all medical services provided to Medicaid recipients during their hospital stays. To determine whether ambulatory and laboratory service providers were inappropriately paid for services provided to Medicaid recipients during their hospital stays, we examined selected Medicaid payments to these providers over a five-year period. We identified more than $2.3 million in inappropriate payments. We recommended that the Department of Health recover the overpayments and develop controls to prevent such overpayments in the future.
We also determined that an additional $622,937 in payments could also be inappropriate. We could not make a conclusive determination because the providers were not required to report certain cost information to the Department of Health. We recommended that the providers be required to report this information.
For a complete copy of Report 2006-S-90 click here.
For a copy of the 90-day response click here.
For a copy of the associated follow-up report click here.