Office of Inspector General's Partnership Plan-State of Montana's Medicaid Third Party Liability Program

This final report addresses the effectiveness of procedures used by Montana's Department of Public Health and Human Services (DPHHS) and its Medicaid contractor to ensure Medicaid is the payer of last resort. The audit was made by the Montana Legislative Audit Division (LAD) as part of the Office of Inspector General's partnership efforts with State auditors to expand audit coverage of the Medicaid program. The LAD found that, overall, the State agency properly denied payment for medical services that were the responsibility of third parties and appropriately denied duplicate claims that were submitted for the same services, ensuring that Medicaid was the payer of last resort. However, the LAD did note some procedural weaknesses, and recommended that DPHHS establish policies to ensure compliance with the State's statute requiring the recording of receivables and disposition of uncollectible revenue and complete an analysis of the recovery of Medicaid funds to determine if procedures used for recovery maximize collection efforts. The DPHHS concurred with the recommendations.