Corporate Compliance

GOV’T AUDIT INSIDER: Medicaid overpayments go unreported in Colorado

Healthcare Auditing Weekly, August 10, 2004

Colorado Department of Health Care Policy and Financing did not report all Medicaid provider overpayments during the period of October 1, 2002, through September 30, 2003, according to an OIG audit report.  Under law, states are required to return the federal share of overpayments on CMS 64 reports within 60 days of the date they were discovered.  The OIG found that the Colorado agency did not report the overpayments in accordance with regulation and delayed returning $469,756 of the federal share.  Of that amount, the agency had not returned or reported $334,698 as of February 11.  The OIG recommends that the funds be returned as soon as possible and that the agency strengthen its policies and procedures.  During the audit, the OIG did the following:

  • Reviewed applicable federal criteria

  • Interviewed state agency officials and staff responsible for identifying, monitoring, and reporting the federal share of overpayments

  • Reviewed documentation for date of discovery, overpayment status, and adjustments or write-offs

  • Compared the state agency's CMS 64 reports to supporting documentation

  • Verified accounting transactions for overpayments reviewed

  • Calculated and analyzed the number of days between actual and required reporting dates and overpayments

  • Calculated potential lost interest

    Click here to read the audit report, "Review of Colorado's Accounts Receivable System for Medicaid Provider Overpayments" (A-07-04-03049), released July 8.

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