The HHS Office of Inspector General is conducting audits in several states to ensure Medicaid is not overpaying hospitals for care given to the roughly 8.3 million dual eligibles.
Dual eligible beneficiaries are low-income seniors and people with disabilities who are covered by both Medicare and Medicaid. However, as the OIG has emphasized: "Medicaid is the payer of last resort and should not pay for medical costs when there is another responsible entity (or program), including Medicare."
Most recently, the OIG investigated South Carolina. The agency looked at Medicaid claims from 2007 through 2009, submitted by 52 hospitals.
The OIG found the state overpaid some Medicaid inpatient claims from hospitals even though hospitals had already received Medicare reimbursement for the same services. Overpayments totaled almost $1.06 million.
South Carolina's Medicaid program must recover the overpayments and refund the federal government's share, which totaled almost $800,000. South Carolina officials agreed with the OIG's findings. In addition, the Medicaid agency plans to replace its IT system and conduct post-payment audits on hospitals to ensure duplicate Medicare-Medicaid payments are not made again.
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