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Audit (A-05-09-00049)

12-22-2010
Review of Medicaid High-Dollar Payments for Inpatient Services in Illinois From January 1, 2006 Through September 30, 2007-Hospitals With Five or More High-Dollar Payments

Executive Summary

Of the 224 high-dollar Medicaid payments that the State made to hospitals for inpatient services, 75 were allowable. The remaining 149 payments included overpayments totaling $2.1 million ($1.1 million Federal share). For 110 of the 149 payments, hospitals reported incorrect charges that resulted in unallowable outlier payments; for 39 payments, hospitals reported incorrect charges that resulted in unallowable payments for transplant procedures. Hospital officials attributed the incorrect charges primarily to data entry errors.

We recommended that the State agency refund $1.1 million to the Federal Government and use the results of this audit in its provider education activities. In written comments on our draft report, the State concurred with our findings. However, it stated repayment of the Federal share will not be required since all claims have been resubmitted via the voiding process.

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