Maine will have to repay roughly $9.2 million to the federal government after the Office of Inspector General (pdf) found that the state's Medicaid agency incorrectly processed claim adjustments.
The OIG looked at Maine's Medicaid claims between 2005 and 2009, which totaled $218 million, attempting to find out if Maine's Medicaid agency used the correct federal medical assistance percentage when it processed claim adjustments. FMAP adjustments are made for several reasons, including correcting inaccurate provider billings and retroactive changes in provider payment rates.
Of the more than 637,000 claims reviewed, the OIG found roughly 573,000 claim adjustments used an incorrect FMAP. "These errors occurred because [Maine's Medicaid] agency processed the whole amount of adjusted private-provider claims as new expenditures rather than treating only the increases as new expenditures," according to the report.
In addition to repaying the $9.2 million, the OIG recommended Maine's Medicaid program ensure it processes future adjustments using the correct FMAP.
The OIG looked at Maine's Medicaid claims between 2005 and 2009, which totaled $218 million, attempting to find out if Maine's Medicaid agency used the correct federal medical assistance percentage when it processed claim adjustments. FMAP adjustments are made for several reasons, including correcting inaccurate provider billings and retroactive changes in provider payment rates.
Of the more than 637,000 claims reviewed, the OIG found roughly 573,000 claim adjustments used an incorrect FMAP. "These errors occurred because [Maine's Medicaid] agency processed the whole amount of adjusted private-provider claims as new expenditures rather than treating only the increases as new expenditures," according to the report.
In addition to repaying the $9.2 million, the OIG recommended Maine's Medicaid program ensure it processes future adjustments using the correct FMAP.
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