Acute-Care Hospitals in Ohio Did Not Always Reconcile Invoice Records With Credit Balances and Refund the Associated Medicaid Overpayments to the State Agency

The eight hospitals that we sampled did not always reconcile invoice records with credit balances and refund the associated Medicaid overpayments to the Office of Medical Assistance (State agency). Of the 240 invoice records with both Medicaid payments and credit balances in our sample, 43 contained Medicaid overpayments, but 197 did not. The Medicaid overpayments associated with the 43 invoice records totaled $41,000 ($26,000 Federal share). On the basis of our sample results, we estimated that the State agency could realize an additional Statewide recovery of $4.6 million ($3 million Federal share) from our audit period and obtain future savings if it enhanced its efforts to recover overpayments in hospital accounts.

The hospitals did not always identify and report Medicaid overpayments because the State agency did not require hospitals to reconcile invoice records to determine whether overpayments existed. The reconciliation process was at the discretion of the hospitals.

We recommended that the State agency (1) refund $26,000 to the Federal Government for overpayments paid to the selected hospitals and (2) enhance its efforts to recover additional overpayments estimated at $4.6 million ($3 million Federal share) from our audit period and realize future savings by requiring hospitals to reconcile invoice records with credit balances and reporting the associated Medicaid overpayments. The State agency did not concur with all of our recommendations but stated that it had recovered all of the overpayments that we identified.