Corporate Compliance

GOV’T AUDIT INSIDER: OIG finds possible duplicate Medicaid claims in NH

Healthcare Auditing Weekly, March 8, 2005

OIG finds possible duplicate Medicaid claims in NH

The New Hampshire Medicaid agency claimed $548,740 in suspected duplicate claims for the period of January 1, 2000 to June 30, 2002, according to an OIG audit report. The audit found that New Hampshire's Medicaid Management Information System (MMIS) was insufficient at determining whether to deny or pay possible duplicate claims, and that 9,000 were paid without being properly investigated. The OIG recommends that New Hampshire refund the federal share of overpayments, strengthen its MMIS system, and train staff in proper investigation of possible duplicate claims.

During the audit, the OIG did the following:

  • Reviewed applicable state and federal laws and regulations

  • Obtained an understanding of the claims resolutions procedures

  • Obtained all Medicaid claims processed by the New Hampshire agency

  • Identified all suspected duplicate claims

  • Matched the identified claims to the original claim

  • Focused review on Medicaid medical, dental, nursing home, and outpatient files

  • Held discussions with appropriate officials and staff

  • Provided New Hampshire Medicaid State Utilization Review unit with a database of suspected duplicate claims

  • Reviewed New Hampshire's procedures for suspected duplicate claims

    Click here to read the audit report, "Application Controls at the New Hampshire Medicaid State Agency - Identification of Suspect Duplicate Claims," (A-01-04-00003) issued February 9.

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