Corporate Compliance

Gov’t Audit Insider: Utah state health department fails to report Medicaid overpayments

Healthcare Auditing Weekly, September 21, 2004

The Utah State Department of Health did not report a total of $132,749 for Medicaid provider overpayments from October 1, 2000 through September 30, 2003, according to an OIG audit report. The report is part of a nationwide audit of states' Medicaid provider overpayments. By failing to correctly report the overpayments, the Utah state agency also denied CMS $2,071 in interest. OIG determined that the agency should return the federal share of the overpayments, enforce its own policies and procedures, maintain a record of all claims, and return federal overpayments in a timely manner. During the audit, the OIG did the following:

  • Reviewed applicable federal criteria, sections of the state Medicaid manual, and the agency's policies and procedures

  • Interviewed officials and staff responsible for identifying, monitoring, and reporting collections of overpayments

  • Manually pulled 629 case files

  • Reviewed the credit balance report

  • Compared the CMS 64 reports submitted by the state agency to supporting documentation

  • Used the Medicaid Management Information System to verify the collection of some overpayments

  • Calculated the number of days between the actual and required reporting dates, using a cutoff date for those overpayments that remained unreported during the audit

  • Calculated CMS' potential lost interest

    OIG conducted the audit at the Utah State Department of Health from February through June 2004. Click here to read the audit report, "Review of Utah's Accounts Receivable System for Medicaid Provider Overpayments" (A-07-04-0351), issued August 19.

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