Medicaid Audits to Target Overpayments

Audits of Medicaid claims began in November 2009 in two dozen states including Pennsylvania.

The audits will look for overpayments to health care providers or facilities who receive federal Medicaid funding.

Claims from a variety of Medicaid providers in different types of practices and who provide different services will be reviewed at random. The audits seek to reduce inappropriate, incorrect, or fraudulent Medicaid claims and limit fraud and waste.

The Centers for Medicare and Medicaid Services has contracted with Maryland-based Health Integrity to conduct the audits.

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Comments: 1


We just received a refund request for services from 2006. The claim was paid in December 2006 and they have changed their mind dated 05/05/2010 to request a refund because the patient isn't responding to their request for other Insurance. At this point does it matter. Timely filing accross the board will not get the claim paid. Do we have to refund?

Jo at 5/11/2010 3:08:53 PM

Last Updated: 12/15/2009
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