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Audit (A-04-11-06137)

05-07-2013
North Carolina Medicaid Overpaid Hospitals for Some Inpatient Services That Medicare Paid

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Summary

North Carolina overpaid some Medicaid inpatient claims from hospitals that had received Medicare payments for the same services. Of the 657 overpayments ($3 million Federal share) that we reviewed for the 3-year period January 1, 2007, through December 31, 2009, the hospitals had refunded 533 prior to our audit. However, the hospitals had not refunded the remaining 124. The hospitals had not refunded half of the 124 Medicaid overpayments because of system errors, but we cannot comment on why the hospitals had not refunded the remaining 62 overpayments because the State agency could not provide documentation. As a result, the State agency made Medicaid overpayments to hospitals totaling $576,000 ($402,000 Federal share).

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