Performance Improvement 2009. Are Erroneous Fee-for-Service Payments Made for Capitated Medicaid Managed Care Services?

01/01/2009

This study determined which Medicaid programs paid non-institutional fee-for-service claims for services provided to beneficiaries enrolled in capitated Medicaid managed care plans. In capitated Medicaid managed care arrangements, State Medicaid programs pay managed care plans a fixed rate per Medicaid beneficiary in exchange for services included in the plan.

Four of the five State Medicaid programs included in the review reimbursed fee-for-service claims $864,000 in error, and two State Medicaid programs potentially paid an additional $974,006 in error for the same quarter. The agency planned to (1) remind States of the importance of eliminating erroneous payments and recommend that States make necessary edits to their payment systems at the next Medicaid Managed Care Technical Advisory Group call and (2) work with States to voluntarily collect the overpayments associated with the erroneous fee-for-service payments.

Report Title: Fee-For-Service Payments For Services Covered By Capitated Medicaid Managed Care http://oig.hhs.gov/oei/reports/oei-07-05-00320.pdf
Agency Sponsor: OS-OIG, Office of Inspector General
Federal Contact: Erin Lemire, 202-205-9523
Performer: Staff; Office of Inspector General
PIC ID: 9002

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