Department of Health

Potential Overpayments of Medicaid Provider Claims for Human Immunodeficiency Virus (HIV) Primary Care Services

Medicaid provides an annual evaluation, periodic testing and monitoring services (primary care services) to recipients with the Human Immunodeficiency Virus (HIV). These services are subject to certain frequency limits. However, when we examined the Medicaid claims submitted by clinics over a three-year period for HIV primary care services, we identified a number of instances in which these frequency limits appear to have been exceeded. For example, in 2006, a clinic billed Medicaid for 12 annual evaluations for the same recipient. We identified a total of about $2.4 million in potential overpayments to 174 such clinics. We recommended that the Department of Health investigate the potential overpayments, recover all actual overpayments, and develop controls to prevent such overpayments in the future.

For a complete copy of Report 2008-S-5 click here.
For a copy of the 90-day response click here.