North Carolina Did Not Always Make Correct Medicaid Claim Adjustments

The North Carolina Division of Medical Assistance (State agency) did not always use the correct Federal medical assistance percentages (FMAPs) when processing claim adjustments reported to the Centers for Medicare & Medicaid Services. Of the 9.2 million claims we reviewed, the State agency processed 1.9 million claims using incorrect FMAPs resulting in no impact. However, the remaining 7.3 million claims were paid using incorrect FMAPs resulting in a net overpayment. As a result, the State agency received $1.6 million (Federal share) more in Federal reimbursement than it was entitled to. These errors occurred because the State agency did not have adequate internal controls to process claim adjustments in accordance with Federal requirements.