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Noninstitutional Providers in California Did Not Always Reconcile Invoice Records With Credit Balances and Refund to the State Agency the Associated Medicaid Overpayments

Of eight noninstitutional providers that we sampled, two providers always reconciled invoice records, one provider never reconciled invoice records, and five providers did not always reconcile invoice records with credit balances and refund to the California Department of Health Care Services (State agency) the associated Medicaid overpayments. For 5 providers, we sampled a total of 129 invoice records with Medicaid credit balances that were unresolved for at least 60 days and found that 63 contained Medicaid overpayments, totaling $7,000 ($4,000 Federal share). Using these results, we estimated that the State agency could realize an additional statewide recovery of $1.1 million ($619,000 Federal share) from noninstitutional providers and obtain future savings if it enhanced its efforts to recover Medicaid overpayments in provider accounts.

Filed under: Center for Medicare and Medicaid Services