Department of Health

Medicaid Claims Paid in 1996 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 selected inpatient hospital claims paid by Medicaid during 1996 on behalf of individuals who were eligible for both Medicaid and Medicare. We determined that as much as $15.2 million in Medicaid may have been overpaid, mainly because health care providers had not billed Medicare or because Medicare payment information recorded on Medicaid claims did not agree with the actual Medicare claims. We recommend that the Medicaid overpayments be investigated and recovered.

For a complete copy of Report 97-D-20 click here.
For a copy of the 90-day response click here.