OIG: State agency may be responsible for duplicate payments
Compliance Monitor, September 28, 2005
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The Connecticut Department of Social Services may have overpaid as much as $1.8 million for home healthcare services, the OIG found in a recent audit.
In Connecticut, home healthcare is provided as a benefit in both the Medicaid and Medicare programs. The Connecticut Medicaid program reimburses providers for home healthcare services largely on a fee-for-service basis. The Medicare program, however, uses a home health prospective payment system that provides a lump sum payment for covered services. The objective of the audit was to determine whether the state agency made Medicaid overpayments to dual-eligible beneficiaries (i.e. beneficiaries of Medicare and Medicaid).
For federal fiscal years 2002 and 2003, the OIG identified 3,453 Medicaid claims totaling $1.8 million-including $900,000 in federal dollars-for home healthcare services that overlap, and for which the state may have duplicated reimbursement.
The OIG recommended that the agency
educate its provider community on proper billing practices
consider conducting prepayment edits of selected claims
work with a Medicare regional home health intermediary to develop controls
initiate action to recover the potential overpayments identified
To complete the audit, the OIG
interviewed relevant state officials
consulted with CMS regional staff
evaluated the home healthcare oversight activities identified as potential overpayments through computer matching
discussed coverage policies and reimbursement procedures for the Medicare and Medicaid programs with provider personnel
examined billing and medical records
selected cases for review
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