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Audit (A-04-10-04007)

Review of Medicaid Credit Balances at Private Diagnostic Clinic, PLLC, at Duke University Medical Center as of March 31, 2010

Executive Summary

Some of the Medicaid credit balances recorded for patient services in Private Diagnostic Clinic, PLLC (Duke Clinic)'s accounting records as of March 31, 2010, constituted overpayments. We estimated that the State should return $235,000 ($154,000 Federal share) to Medicaid. Also, Duke Clinic had not submitted to the State the required quarterly Medicaid credit balance report; however, it had previously identified and repaid some overpayments to the State. These deficiencies occurred because Duke Clinic's policies and procedures were not adequate to ensure that it reconciled the invoice records in a timely manner to identify and return overpayments that were due the State.

We recommended that the State (1) refund $154,000 to the Federal Government for overpayments paid to Duke Clinic and (2) work with Duke Clinic to ensure that it reconciles credit balances and identifies overpayments in a timely manner and reports and refunds Medicaid overpayments. The State concurred with our findings and recommendations.

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