Massachusetts health officials over-billed Medicaid for almost $106 million by filing claims from as far back as 1988 as current expenses.
A Department of Health and Human Services inspector general’s report found the state’s health department had improperly adjusted nearly half of the five million claims auditors sampled between 2008 and 2010.
The federal government determines what percentage of Medicaid costs it will cover for each state by measuring its per capita income relative to other states.
While HHS reimbursed 50 percent of Massachusetts’ Medicaid costs in 1988, its share of the program had risen to 61.5 percent by 2010.
Massachusetts health officials inflated the amount of federal funds they said the state was owed by voiding old claims — some of which had been subject to older, lower reimbursement rates — and processing new claims using the current, higher reimbursement rate.
IG auditors said this process occurred when the state adjusted claims for both public and private healthcare providers.
The correct method of adjusting claims would involve billing only the increase allowed by the adjustment, not the entire claim, as a new expenditure.
In addition to recommendations for improving future adjustments, the IG said Massachusetts should return the $106 million in excess Medicaid payments to the federal government.
A 2012 HHS IG report found Maine’s health department had improperly billed Medicaid for almost 90 percent of its claim adjustments.
HHS asked Maine to pay back the more than $9 million the state had netted using the same practice cited in the Massachusetts report.
The Government Accountability Office estimates Medicaid handed out $14.4 billion in improper payments last year alone.
Go here to read the full HHS IG report.
