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GOV’T AUDIT INSIDER: Unreported Medicaid provider overpayments in Missouri

Healthcare Auditing Weekly, June 28, 2005

Missouri's accounts receivable system did not report 34 Medicaid provider overpayments on the quarterly CMS 64 reports, according to an OIG audit report. Due to insufficient policies and procedures, Missouri delayed returning the federal share of overpayments totaling $1.09 million. Of that amount, Missouri had not yet reported or returned to the federal government overpayments totaling $1.06 million as of December 7, 2004. Additionally, Missouri did not reclaim $25,049 (federal share).

The OIG recommends that Missouri return the overpayments to the federal government as soon as possible and strengthen its policies and procedures.

During the audit, the OIG did the following:

• Reviewed applicable federal criteria and state laws and regulations

• Interviewed Missouri officials

• We reviewed overpayment case files, information provided by the Medicaid Fraud Control Unit (MFCU), and other supporting financial documentation

• Compared the CMS 64 reports submitted to CMS to supporting documentation

• Verified the collection of some overpayments with information provided from the Medicaid Management Information System

• Calculated the number of days between the actual and required reporting dates and applied a cutoff date, December 7, 2004, for overpayments that remained unreported during the audit

• Calculated potential lost interest

Click here to read the audit report, "Review of Missouri's Accounts Receivable System for Medicaid Provider Overpayments," (A-07-05-03071), issued May 23.

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