December 10, 2013

GAO Faults CMS for States’ Reporting Medicaid Overpayments

By

Chuck Buck

The Government Accountability Office says that 19 states identified in a federal audit made errors in reporting overpayments that should have been returned to the federal government.

The GAO report was posted on its website on Dec. 6. In the report, that agency said that states recovered $9.8 million in Medicaid overpayments, but did not clearly report the overpayments and the return of the federal share to the Centers for Medicare & Medicaid Services (CMS) within the Department of Health and Human Services (HHS).

“Federal audits initially identified about $20.4 million in potential Medicaid overpayments across the 19 states with identified overpayments from June 2007 through February 2012,” the report stated.

The GAO reported that of the $13.3 million in net overpayments, states recovered $9.8 million and were in the process of recovering the remaining $3.5 million.

According to the GAO, the states in question should have “reported the return of the federal share for $13.3 million on the line designated for overpayments identified by national audit program contractors on the CMS-64—the form that states fill out quarterly to obtain federal reimbursement for Medicaid services.”

The GAO says it undertook the study to examine states’ efforts to recover and report overpayments identified by federal audits, and examine CMS’ review of state reporting. The agency recommended “the CMS Administrator increase efforts to ensure that states are clearly reporting overpayments identified by federal audits in the designated location of the CMS-64 form.”

The agency noted that HHS concurred with its recommendation.

Read the report

Chuck Buck

Chuck Buck is the publisher of RACmonitor and is the executive producer and program host of Monitor Mondays.

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