Review of Delaware's Accounts Receivable System for Medicaid Provider Overpayments

EXECUTIVE SUMMARY:

The objective of this review was to determine whether Delaware reported all identified Medicaid provider overpayments in a timely and accurate manner.  Based on a review of provider overpayments identified during fiscal year 2003, Delaware did not report 3,184 overpayments totaling $838,906 ($437,592 Federal share), did not report 205 overpayments totaling $440,861 ($226,460 Federal share) timely, and  incorrectly netted overpayments against expenditures.  In addition, Delaware incorrectly reported provider overpayments totaling $1,108,545 on the wrong line of the CMS-64 because of an incorrect spreadsheet formula.  We recommended that Delaware (1) include unreported overpayments totaling $838,906 on the CMS-64 and refund the Federal Government $437,592 representing the Federal share, (2) ensure overpayments are reported within 60 days in accordance with Federal regulations, (3) establish an adequate integrated accounting system that records, ages and accurately reports overpayments on the CMS-64, and (4) review and correct the spreadsheet used to consolidate provider overpayments reported on the CMS-64.