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Audit (A-01-10-00008)

Followup Review of Medicaid Cost-of-Care Overpayments Made to Nursing Facilities in the State of Maine

Executive Summary

The Maine Department of Health and Human Services (State agency) did not report Medicaid overpayments totaling $1.68 million from 2008 to 2009 in accordance with Federal requirements (the Federal share of these overpayments is $1.09 million). Federal law requires States to refund the Federal share of a Medicaid overpayment, and Federal regulations require States to refund the Federal share of an overpayment to a provider at the end of the 60-day period following the date of discovery, whether or not the State has recovered the overpayment. These deficiencies occurred because the State agency did not credit the Federal claim until the nursing facilities returned overpayments.

We recommended that the State (1) refund CMS $1.09 million in Medicaid cost-of-care overpayments that it made to nursing facilities on its next quarterly CMS-64 and (2) implement policies and procedures to ensure that overpayments identified are returned in the required amount of time. The State concurred with our recommendations.

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