Review of Medicaid Overpayments at First Atlantic Nursing Facilities in Maine for Calendar Years 2004 Through 2006

EXECUTIVE SUMMARY:

The Maine Department of Health and Human Services made overpayments totaling $1.2 million ($742,000 Federal share) to First Atlantic Healthcare Corporation (First Atlantic) on behalf of an average of 75 Medicaid beneficiaries each month during calendar years 2004'2006. Medicaid requires States to use any additional resources that a beneficiary has, including Social Security payments, to reduce Medicaid payments to nursing homes. However, because of problems with its new computer system, the State did not adjust its Medicaid per diem payments to First Atlantic by the amount of beneficiaries' cost-of-care contribution from other resources, such as Social Security and pensions. We recommended that the State collect overpayments totaling $1.2 million from First Atlantic; refund the $742,000 Federal share of these overpayments; and continue its efforts to ensure that Medicaid overpayments to nursing homes are identified, collected, and refunded. The State concurred with our finding and recommendations.

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