Review of South Dakota's Accounts Receivable System for Medicaid Provider Overpayments

EXECUTIVE SUMMARY:

Our objective was to determine if the State agency reported Medicaid provider overpayments pursuant to Federal regulations.  We found that the State agency did not report all or part of 342 Medicaid provider overpayments due before or during FY 2003 pursuant to Federal regulations.  The State agency did not have sufficient policies and procedures in place to ensure it reported all overpayments pursuant to Federal regulations.  As of January 14, 2005, the State agency had not reported provider overpayments totaling $229,792. Of that amount, the State agency had not returned the Federal share totaling $154,741.

We recommended the State agency should: (1) return to the Federal Government $154,741 of overpayments as soon as possible, (2) ensure the Federal share of all Medicaid provider overpayments is returned within established timeframes, and (3) strengthen policies and procedures to ensure it reports overpayments pursuant to Federal regulations.  Although the State agency agreed with two of our findings, it disagreed with the amount of overpayments, including three overpayments it claimed it made to individuals rather than providers.