New computer system malfunctions, overpayments result
Healthcare Auditing Weekly, June 17, 2008
In January 2005, the Maine Department of Health and Human Services implemented a new computer system to process Medicaid reimbursement claims from healthcare providers. The new system quickly experienced serious malfunctions that resulted in over a million dollars in overpayments.
In the OIG’s audit they examined specifically overpayments to First Atlantic Healthcare Corporation, a Maine healthcare provider with 11 Medicaid-certified nursing homes in the state.
The OIG determined that the state agency overpaid First Atlantic on behalf of an average 75 Medicaid beneficiaries each month during 2004-2006. The overpayments totaled $1,163,847.
- Collect $1,163,847 from First Atlantic and refund the $741,756 federal share of these overpayments to CMS.
- Continue its efforts to ensure that Medicaid overpayments to nursing homes are identified, collected, and refunded.
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