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Department of Health and Human Services

Office of Inspector General -- AUDIT

"Review of Clinical Laboratory Services Provided Under The Iowa Medicaid Program," (A-07-95-01139)

September 27, 1995


Complete Text of Report is available in PDF format (1.4 MB). Copies can also be obtained by contacting the Office of Public Affairs at 202-619-1343.

EXECUTIVE SUMMARY:

This final report provides you with the results of our review of Clinical Laboratory Services Provided Under the Iowa Medicaid Program. Medicaid providers received excess reimbursement estimated at $171,025 during calendar years 1993 and 1994 for clinical laboratory services that were unbundled (not grouped for payment) or duplicated. The State did not have procedures to prevent paying for unbundled or duplicate laboratory services. We recommend the State (1) install edits to prevent payments for unbundled or duplicate services; (2) instruct providers on bundling requirements; (3) identify and recover 1993 and 1994 overpayments from providers; and (4) return the Federal share of recovered overpayments to the Health Care Financing Administration (HCFA). We estimate that the State could save $85,513 (Federal share $53,548) annually or about $427,565 over a 5-year period by implementing bundling and duplicate edit procedures.