Corporate Compliance

Medicare, Medicaid mistakenly pay for same services

Healthcare Auditing Weekly, February 10, 2009

The OIG recently discovered that in 2005, five state Medicaid programs made $3.3 million in payments for home health service claims for which Medicare may have also paid.
In its February 2009 report, the OIG reviewed a sample of beneficiary claims for home health services to identify payments that were vulnerable to receiving payment from both Medicaid and Medicare. The programs should not pay for the same skilled nursing and home health aide services for the same beneficiary during the same visit, according to the report. Medicaid covers services that Medicare does not, up to the limits established by the State Medicaid agency.
The OIG attributes these missteps to the “complexity of payment policies for services provided to dually eligible beneficiaries,” as well as poor coordination of care between providers, and a lack of clarity in Medicare coverage policies.
In the report, the OIG did not make official recommendations, but did say CMS could consider methods to improve integration in Medicaid and Medicare claims processing and provide greater clarity in the Medicare Benefit Policy Manual in order to prevent duplicate claims.

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