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IA: Federal officials ding Iowa for inappropriate Medicaid payments

By   /   December 6, 2012  /   News  /   No Comments

By Sheena Dooley | Iowa Watchdog

DES MOINES – The Iowa Department of Human Services inappropriately claimed $211,500 in medical costs for more than 400 low-income patients enrolled in programs that provide medical care to people who don’t qualify for Medicare or Medicaid, a newly released federal report says.

Iowa dinged in federal audit of Medicaid claims.

Officials with the U.S. Department of Health and Human Services Office of Inspector General found in fiscal year 2011 the state submitted and paid claims for patients who received care through the IowaCare and Family Planning programs. Those people, however, were also enrolled in or eligible for Medicare or Medicaid at the same time they received services, which federal law prohibits.

The inappropriate payments represent less than 1 percent of the state’s $107.9 million in Medicaid claims in fiscal 2011, according to the report. The programs receive funding through federal Medicaid and state dollars.

“It’s a small amount,” said Donald White, spokesman for the Office of Inspector General. “There are audits like this going on in states around the country. It’s not that unusual.”

Specific findings in the report include:

IowaCare provides medical care for Iowans who aren’t eligible for Medicare or Medicaid. Officials, however, paid $157,168 in claims for patients who were eligible or receiving services from the two programs.

Roughly 30 women received optional breast or cervical cancer treatments under a program that helps those who don’t have insurance. They, however, qualified for Medicare or Medicaid, causing inappropriate payments of $46,012.

Medicaid payments were made for 28 women who received care through the Family Planning program even though they qualified for Medicare and Medicaid, which resulted in $8,300 in inappropriate payments.

Roger Munns, spokesman for the Iowa Department of Human Services, referred to the department’s written response to federal officials when asked for comment. State officials agreed with the findings and recommendation that they refund the $147,615 in federal dollars they received.

“The percentage is small – there is nothing else for us to add,” Munns said.

The audit is part of the federal governments’ increased focus on Medicaid spending. Congressional committee members and officials at the U.S. Department of Health and Human Services put a greater emphasis on oversight of Medicaid spending in recent years as more states struggle to offset increasing costs, White said.

That has prompted reviews of state Medicaid spending across the country.

“In the past there was a lot of focus put on Medicare,” White said. “There is an emphasis now on Medicaid, because it puts such a drain on state budgets and federal government.”

Sheena Dooley can be contacted at [email protected]

— Edited by John Trump at [email protected]


Sheena formerly served as staff reporter for Watchdog.org.