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

EXECUTIVE SUMMARY:

Our objective was to determine if the Department reported overpayments in accordance with Federal regulations.  We found that the Department did not report 10 overpayments totaling $169,068 ($85,430 Federal share) because provider appeals had not been finalized.  When we brought these overpayments to the Department's attention, it reported them on the CMS-64 for the quarter ended March 31, 2004.  The Department did not report 95 overpayments totaling $3,226,166 ($1,630,182 Federal share) within the required timeframe because it did not use the correct discovery date, and incorrectly reported a bankruptcy credit adjustment of $1,260,760 on Line 2 rather than Line 4 of supplemental schedule CMS-64.90.  The inaccurate reporting resulted in CMS having incorrect Medicaid expenditure and overpayment data.  This also potentially resulted in higher interest expense to the Federal government of approximately $9,500.  The Department generally agreed with our report and has already taken steps to address our recommendations.