Review of Medicaid Home Health Payments Rendered During a Medicare Covered Stay For Dual Eligible Beneficiaries State of Connecticut October 1, 2001 Through September 30, 2003

EXECUTIVE SUMMARY:

Our objective was to determine whether the Connecticut Department of Social Services (the State agency) made Medicaid payments for home health care services provided to dual eligible beneficiaries that duplicated payments already reimbursed through a Medicare prospective payment system.  For Federal fiscal years 2002 and 2003, we identified 3,453 Medicaid claims totaling $1.8 million ($900,000 Federal share) for home health care services that overlap and may have duplicated reimbursement already made under the Medicare program.  We recommended that the State agency educate its provider community on proper billing practices, consider conducting prepayment edits of selected claims, work with the Medicare regional home health intermediary to develop controls for identifying and recouping Medicaid payments that should have been covered under Medicare, and initiate action to recover the potential overpayments identified in this audit.  The State agency agreed with our recommendations for educating providers and working with CMS on recovery actions but disagreed that it did not have proper safeguards to ensure that Medicaid was the payer of last resort.

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