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

This review was part of a multistate audit focusing on States’ accounts receivable systems for Medicaid provider overpayments. Our objective was to determine whether the State agency reported Medicaid provider overpayments in accordance with Federal requirements. The Department of Health and Human Resources did not report overpayments totaling $3,774,106 ($2,940,469 Federal share) to CMS because it was waiting to implement changes to its Medicaid Management Information System and did not report overpayments totaling $3,280,807 ($2477,041 Federal share) within the required timeframe because of an oversight and because it did not use the correct date of discovery. This nonreporting and untimely reporting also potentially resulted in approximately $20,000 in higher interest expense to the Federal Government.

We recommend that the Department of Health and Human Resources: (1) include unreported overpayments totaling $3,744,106 on the CMS-64 and refund the $2,940,469 to the Federal Government, (2) determine the value of overpayments identified after our audit period that have not been reported and include them on the CMS-64, and (3) ensure that all future overpayments are reported within 60 days in accordance with Federal regulations, thereby mitigating the potentially higher interest expense to the Federal Government.