Clinical Laboratory Services Provided Under the Missouri Medicaid Program

This final audit report points out that the State agency did not have procedures to prevent paying for unbundled or duplicated claims for certain laboratory services. A statistical sample of 150 claims showed that 121 claims were overpaid. We estimate the overpayments totaled $653,315 (Federal share) for unbundled or duplicated laboratory tests for calendar years 1993 and 1994. In addition to recommendations calling for financial adjustments, we recommended that the State agency install edits to prevent payments for unbundled or duplicate services and instruct providers on bundling requirements.