Another day, another State attempt to recoup Medicaid funds from a provider

Again, today, I will attend yet another Medicaid reconsideration review in lieu of the State’s ever-increasing attempts to recoup already-spent Medicaid dollars. Per norm, the State has authorized my client, a health care provider, to provide Medicaid services (in this case, community support team) to hundreds of Medicaid recipients. A couple years after the State authorized the services, the State has turned around and “un-authorized” the services. Why? Because the State needs money. So, the State reviewed this provider’s Medicaid documents (service authorizations, service notes, PCPs) and found any possible mistake in order to seek recoupment. For example, CCA (assessments) that were electronically signed are, now, not valid. Or if the State could only find one service note for 8 units and the provider billed for 16 units, the State has put the burden on the provider to find the additional service note. Or 2 years ago, the QP accidentally put a date with no time on the service note.

It is worth noting that when the State issues a Tentative Notice of Overpayment, the amount sought is in the hundreds of thousands. This amount would put most health care providers out of business. They rely on the State’s authorization of services. If they do not rely on the State’s authorization, very few providers would exist.  It simply would be too risky to provide Medicaid services. Is this where we are heading?

About kemanuel

Medicare and Medicaid Regulatory Compliance Litigator

Posted on November 7, 2012, in Medicaid Recoupment and tagged , , , , , , , . Bookmark the permalink. Leave a comment.

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