The Office of Inspector General (OIG) released a report in April entitled Review of Medicaid High-Dollar Payments for Inpatient Services in Michigan from January 1, 2007 Through March 31, 2009 that reviewed whether certain high-dollar Medicaid payments (defined as payments of $200,000 or more) “made to hospitals for inpatient services were based on accurate charges and adequate documentation.” The OIG audit of 204 high-dollar payments revealed that 25% of the payments made were based on inaccurate charges or inaccurate documentation, consisting of 52 overpayments totaling $641,184 and one underpayment totaling $682,537. 151 payments were based on accurate charges and documentation. As a result, the OIG recommended the Michigan Department of Community Health monitor Medicaid expenditures more closely by:
• Using the results of the OIG audit in its provider education activities related to data entry procedures and proper documentation; and
• Periodically review high-dollar Medicaid payments to hospitals.
For more information, please contact Abby Pendleton, Esq. at (248) 996-8510 or (212) 734-0128 or visit the HLP website.