Department of Health
Office of Temporary and Disability Assistance
Medicaid Claims Paid for Medicare Part A 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 individual's eligible medical costs are generally paid by Medicare. We examined a sample of inpatient hospital claims paid by Medicaid during 1995 on behalf of individuals who were eligible for both Medicaid and Medicare. We determined that $6.6 million of the claims should have been paid by Medicare rather than Medicaid. For claims totaling $4.6 million, health care providers had never billed Medicare; for claims totaling $2 million, the providers had billed, and received payment from, both Medicare and Medicaid. We noted that 22 providers accounted for 78 percent of the inappropriate billings. We recommend that the $6.6 million in Medicaid overpayments be investigated and recovered.
For a complete copy of Report 97-D-16 click here.
For a copy of the 90-day response click here.