- The Washington Times - Wednesday, September 21, 2005

Federal auditors want the D.C. government to refund more than $2 million after discovering Medicaid overpayments to hospitals and other health providers for treatment to the poor.

The Office of the Inspector General for the U.S. Department of Health and Human Services made the recommendation in an audit released last week. The report did not indicate any misspending or fraud related to the overpayments.

But auditors did note problems in the District’s Medicaid accounting practices. The audit reviewed Medicaid payments between 2001 and 2002.

“The District did not report all overpayments in accordance with federal requirements,” the auditors wrote.

The audit recommended that the District include unreported overpayments totaling nearly $4 million in filings with the Centers for Medicare & Medicaid Services (CMS), a federal agency within the U.S. Department of Health and Human Services, and that the city refund an estimated $2.19 million.

Medicaid is funded jointly by the federal and state governments, including the District, to provide health care coverage for the poor.

Federal rules require that states, which administer the program, notify federal regulators about any overpayments within 60 days of discovering them.

States also must file quarterly reports with CMS, listing overpayments as an offset to expenditures, according to the audit.

However, in a review of Medicaid payments from October 2001 through September 2002, auditors found dozens of instances in which the District either failed to report or delayed reporting overpayments.

In a written response to federal auditors, Associate D.C. Chief Financial Officer Deloras Shepherd stated that the District did not report 25 Medicaid overpayments totaling nearly $4 million.

She stated the overpayments went unreported because they were under appeal and had not been collected from providers.

“Based on the findings of this audit, the District has changed its practice of reporting overpayments,” Miss Shepherd wrote in a July 21 letter to the Department of Health and Human Services’ Office of the Inspector General.

Previously, the District only reported overpayments when they were collected or at the end of the fiscal year, Miss Shepherd stated.

D.C. Medicaid officials were not available for comment yesterday.

Among hospitals identified by the District as receiving overpayments were the HSC Pediatric Center (formerly known as the Hospital for Sick Children), National Rehabilitation Hospital and Sibley Memorial Hospital.

Miss Shepherd stated in her letter to federal auditors that city officials have recouped some of the funds and now owe $930,321 to the CMS.

The inspector general’s report was the latest in a series of nationwide audits on states’ accounting systems monitoring Medicaid overpayments.

In January, federal auditors found that Virginia failed to report 10 Medicaid overpayments totaling $169,068.


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