Missouri Did Not Always Correctly Claim Medicaid Costs for Selected High-Dollar Outpatient Claims

The Department of Social Services, Missouri HealthNet Division (the State agency), did not always claim Medicaid costs for selected high-dollar outpatient service claims during calendar years 2008 through 2010 pursuant to Federal and State requirements. We referred to outpatient services whose claims included at least one line item paid amount greater than $10,000 as "high-dollar outpatient service claims." Of the 411 high-dollar outpatient service claims that the State agency claimed for payments it made to providers during the audit period, 211 were allowable. For the remaining 200 high-dollar outpatient service claims, providers reported incorrect charges and could not provide documentation to support that some of the outpatient services were provided. This resulted in overpayments totaling $321,000 ($226,000 Federal share).