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Indiana Did Not Always Make Correct Medicaid Claim Adjustments

The Indiana Family and Social Services Administration (State agency) did not always use the correct Federal Medical Assistance Percentages (FMAPs) when processing Medicaid claim adjustments reported on the CMS-64. Of the 23,693,045 Medicaid claim adjustments we reviewed, we determined that 23,274,319 adjustments used the correct FMAP or did not result in a payment difference. However, the remaining 418,726 claim adjustments were paid using incorrect FMAPs, resulting in a net overpayment to the State agency of $1.9 million (Federal share). These errors occurred because the State agency did not have adequate internal controls to process public provider claim adjustments in accordance with Federal requirements. Specifically, the State agency did not report public provider increasing claim adjustments using the FMAP associated with the original claim as required.

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