Utah Did Not Properly Pay Some Medicare Deductibles and Coinsurance

The Utah Department of Health, Division of Medicaid & Health Financing (State agency), claimed unallowable Medicaid payments of $905,000 ($660,000 Federal share) during fiscal years 2011 and 2012. The State agency did not limit payment of Medicare deductibles and coinsurance by State Medicaid plan rates as required under the State plan. Because Federal requirements provide that a State plan for medical assistance is mandatory upon the State and all of its political subdivisions, these claims thus violated Federal requirements as well as the requirements of the State plan.

These errors occurred because the State agency did not compare the Medicare payment to the State Medicaid plan rate as required by the State plan. The State agency did not make this comparison because it did not have policies and procedures requiring it to do so for all Medicare crossover claims.