Review of the Georgia Department of Medical Assistance's Reimbursement for Clinical Laboratory Services Under the Medicaid Program

EXECUTIVE SUMMARY:

This final audit report points out that the Georgia Department of Medical Assistance (State agency) does not have adequate edits in place to prevent the payment of unbundled or duplicated claims for certain laboratory services. A statistical sample of 150 claims showed that 141 claims were not paid correctly. We estimate that the State agency overpaid and should recover form providers $2,151,967 (Federal share) for unbundled/duplicated laboratory tests for calendar years 1993 and 1994. We recommended that the State agency install edits to detect and prevent payments for unbundled services and billings which contain duplicative tests, in addition to recommendations calling for financial adjustments. The State agency concurred with our recommendations.