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OIG: Massachusetts hospital should return overpayments

Healthcare Auditing Weekly, May 28, 2007

The OIG recommends a Massachusetts hospital repay $15,738 to the state's Medicaid program following an audit that revealed the hospital held on to overpayments longer than it should have.

The OIG identified 122 overpayments greater than 60 days old that Baystate Mary Lane Hospital should have returned to the Medicaid program. The errors occurred because the hospital did not follow its internal procedures for processing and returning Medicaid overpayments, according to the OIG.

The $15,738 includes a federal share of $7,869.

Title XIX of the Social Security Act authorizes federal funds to states for Medicaid programs that provide medical assistance to low-income and disabled individuals. Each state Medicaid program reimburses providers for these services.

Credit balances generally occur when the reimbursement that a provider receives for services provided to a Medicaid beneficiary exceeds the charges billed, such as when a provider receives a duplicate payment for the same service from the Medicaid program or another third party-payer. In these cases, the provider should return the existing overpayment to the Medicaid program.

Click here to view the audit, "Review of Medicaid Credit Balances at Baystate Mary Lane Hospital for the Period Ending June 30, 2006 (A-01-06-00010)."

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