Ohio's Department of Medicaid didn't always comply with requirements of the Patient Protection and Affordable Care Act in its review of cases where there were credible allegations of fraud between July 1, 2011, and June 30, 2013, according to a recent audit from HHS' Office of Inspector General.
States are required under the PPACA to suspend Medicaid payments to providers when they get a credible allegation that the providers have submitted fraudulent claims. However, of the 401 cases for which the Ohio Department of Medicaid found credible allegations of fraud by Medicaid providers, the state agency provided good cause not to suspend payments in 321 cases, according to the OIG. For the remaining 80 cases, the Ohio Department of Medicaid suspended payments to providers but continued to pay claims associated with 24 of the 80 cases and received federal reimbursement totaling about $97,000.
"Contrary to federal requirements, the (department) continued to pay suspended Medicaid providers for claims with dates of service that occurred before the providers' suspension date," the OIG wrote.
The OIG recommend that the Ohio Department of Medicaid make sure it properly suspends all Medicaid payments to a provider when it determines that there is a credible allegation of fraud.
The department concurred with the OIG's recommendation and provided details about corrective actions that were implemented.
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