Politics & Government

NC disputes federal audit’s claims of Medicaid payment mistakes

The state made mistakes on more than 9 million adjusted Medicaid payments reviewed in a recent audit, the federal government says. Those mistakes, it adds, cost the federal government $1.5 million over five years — money the state should repay.

The stated denies the audit’s findings, saying the payments were correct.

The disputed errors were reported in a recent audit by the Office of Inspector General in the U.S. Department of Health and Human Services.

The state and federal government share the cost of Medicaid, the government health insurance program for poor children and some of their parents, the elderly and the disabled. The federal government pays about two-thirds of the cost, but the percentage fluctuates. The state is responsible for keeping up with the changes and making sure that the share of Medicaid bills charged to the federal government is accurate.

The federal audit was the second recent review of Medicaid claims that reported mistakes. A state audit released Monday said the state paid providers who had not filed the correct documents, paid providers not eligible to render services, or paid incorrect rates.

The federal audit looked at claims adjustments from July 2008 through June 2013. The state adjusts payments to correct mistakes or impose retroactive rate changes. In making the adjustments, the state must use the federal cost-sharing percentage in effect at the time of the payment.

But the state used the wrong formula for all of the adjusted claims, with 7.3 million of the mistakes resulting in a net financial impact of $1.5 million in federal overpayments, the audit said. The remaining 1.9 million errors did not have a financial impact, it said.

“These errors occurred because the state agency’s internal controls did not adequately ensure that it processed and reported all private and public provider claim adjustments in accordance with federal requirements,” the audit said.

However, the state Department of Health and Human Services said it did use the correct formulas and checked with the federal Centers of Medicare & Medicaid Services to make sure they were right.

According to DHHS, the Office of Inspector General will send a recommendation to the Centers for Medicare & Medicaid Services, and that agency will decide whether or not to seek repayment.

Lynn Bonner: 919-829-4821, @Lynn_Bonner

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