Florida Medicaid Overpaid Hospitals for Some Inpatient Services That Medicare Paid

Florida overpaid some Medicaid inpatient claims from hospitals that had received Medicare payments for the same services. Of the 290 overpayments ($522,000 Federal share) that we reviewed, the hospitals had refunded 143 prior to our audit. However, the hospitals had not refunded the remaining 147. The overpayments were due to the State's lack of system edits to detect erroneous hospital entries in their payment system. As a result, the State agency made Medicaid overpayments to hospitals totaling $282,000 ($186,000 Federal share).