Office of Inspector General's Partnership Plan--State of Ohio Office of the Auditor Report on Clinical Laboratory Services

This final report provides results on the Ohio Office of the Auditor's (OOA) audit of Medicaid clinical laboratory services in Ohio for Calendar Years (CY) 1993 and 1994. This work was conducted as part of the OIG's partnership efforts with State Auditors to expand audit coverage of the Medicaid program. The OOA determined that Ohio's Department of Human Services was reimbursing providers for laboratory services that were not properly grouped together or that were duplicated for payment purposes. The OOA estimates that ODHS overpaid these providers by $5.2 million (Federal share $3.2 million) in CYs 1993 and 1994. The overpayments occurred because ODHS's Medicaid processing section did not have adequate edit routines built into the computer programs used to screen provider billings. The OOA recommended that the State agency develop edit routines that would detect unbundled and duplicate billings prior to payment and install the routines in the programs ODHS uses to screen provider billings. The Chief of Internal Audits of ODHS concurred with the findings.