This final report found that States are not adequately monitoring Medicaid overpayments to providers. We found that 19 State agencies do not have any method to identify Medicaid credit balances and recover overpayments. We recommended that HCFA establish a national Medicaid credit balance reporting mechanism similar to the Medicare Part A credit balance reporting procedures. The HCFA should consider modifying the Medicare procedures to make them viable for the Medicaid program. Further, HCFA should allow individual States the option of an exemption from or adjustment to the basic reporting system. We also recommended that HCFA regional offices actively monitor the national Medicaid credit balance reporting mechanism. The HCFA agreed with our recommendations.