Corporate Compliance

GOV’T AUDIT INSIDER: Late and unidentified overpayment reporting in Delaware

Healthcare Auditing Weekly, November 16, 2004

Delaware's Department of Health and Social Services did not report identified overpayments until they were collected and did not report collected provider overpayments in an accurate and timely manner, says an OIG audit report. Specifically, the department didn't report 3,184 overpayments because it hadn't collected them; didn't report 205 overpayments within the required time frames; and incorrectly netted overpayments against expenditures. The OIG recommends that the department include unreported overpayments on the CMS-64 and refund the federal government its appropriate share. It also says the department should ensure that overpayments are reported within 60 days, establish an adequate accounting system, and review and correct the spreadsheet formulas that are used. During the audit, the OIG did the following:

  • Reviewed applicable federal and state criteria

  • Reviewed prior year audit reports

  • Interviewed key staff and reviewed records

  • Analyzed CMS-64 reports and supporting documentation for fiscal year 2003

  • Reviewed a listing of uncollected accounts receivable that were at least 60 days old as of December 31, 2003

  • Selected a judgmental sample of 51 uncollected accounts receivable and traced them to source documents

  • Determined the total recoupment amount for the audit period

  • Calculated the number of days between the actual and required reporting dates for all identified overpayments and late reported payments, and calculated the potential lost interest

    Click here to read the audit report, "Review of Delaware's Accounts Receivable System for Medicaid Provider Overpayments ," (A-03-04-00205), issued October 13.

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