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Maine Did Not Always Make Correct Medicaid Claim Adjustments

The Maine Department of Health and Human Services (State agency) did not always use the correct Federal Medical Assistance Percentage (FMAP) when processing claim adjustments reported on the Form CMS-64, the Quarterly Medicaid Statement of Expenditures for the Medical Assistance Program. As a result, the State agency incorrectly claimed $9.2 million (Federal share) for Medicaid claim adjustments.

These errors occurred because the State agency processed the whole amount of adjusted private-provider claims as new expenditures rather than treating only the increases as new expenditures.

We recommended that the State agency (1) refund $9.2 million to the Federal Government and (2) ensure that it processes future adjustments using the correct FMAP. The State agency agreed to work with the Centers for Medicare & Medicaid Services to refund identified overpayments and to determine the proper processing and reporting of future adjustments.