Resources
OIG Audit Report- April 20, 2011
Inadequate documentation and Inaccurate Charges
OIG audit finds 25% of high dollar Medicaid claims were paid in error (average error - over payment $12,330). Two reasons 1) inaccurate charges or 2) inadequate documentation. YPRO's CDIS, Audits and education can prevent this. This report will help the RACs to focus on these issues.
SUMMARY OF FINDINGS
Twenty-five percent of the high-dollar Medicaid payments that the State agency made to hospitals for inpatient services were based on inaccurate charges or inadequate documentation. Of the 204 high-dollar Medicaid payments that the State agency made to hospitals for inpatient services, 151 were based on accurate charges and adequate documentation. However, the State agency made 53 payments that were not based on accurate charges or adequate documentation. These inaccurate payments consisted of 52 overpayments totaling $641,184 ($381,596 Federal share) and one underpayment of $682,537 ($384,814 Federal share).
Read the full report at :
http://oig.hhs.gov/oas/reports/region5/50900095.pdf