Medicare Compliance & Reimbursement

Florida managed Medicare companies were the lucky beneficiaries of a costly error by the Florida Agency for Health Care Administration, according to recent audit report from the HHS Office of Inspector General. The state health department made improper fee-for-service payments that managed Medicare plans should have paid, the OIG asserts in "Medicaid Fee-for-Service Payments for Dually Eligible Medicare Managed Care Enrollees" (A-04-02-07007). The watchdog agency recommends that Florida should refund more than $2.2 million to the Centers for Medicare & Medicaid Services for the overpayments, which involved beneficiaries who were eligible for both Medicare and Medicaid. Some of the Florida managed Medicare companies won't keep the extra funds for long - AHCA says it will collect overpaid funds from them in cases where specific documentation of the overpayments is available. Lesson Learned: Managed care organizations should keep in mind that state health departments sometimes struggle with keeping payments straight for dually eligible enrollees. To see the report, go to http://oig.hhs.gov/oas/reports/region4/40207007.pdf.