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Virginia Did Not Always Make Correct Medicaid Claim Adjustments

The Virginia Department of Medical Assistance Services (State agency) did not always use the correct Federal medical assistance percentage (FMAP) when processing claim adjustments reported on Form CMS-64. The State agency used the current FMAP on the date the adjustment was made. In doing so, the State agency repaid to the Federal Government a higher amount than it received for the original claim. Furthermore, when the State agency submitted the revised claim, it received a higher FMAP payment than it should have received. Taking into consideration both of the errors, the net effect resulted in no overpayment or underpayment. The State agency agreed with our finding and concurred with our recommendation.

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Office of Inspector General, U.S. Department of Health and Human Services | 330 Independence Avenue, SW, Washington, DC 20201