The state of Colorado may have to repay the federal government as much as $38.4 million for unallowable bonus payments to the Medicaid program.
Colorado improperly enrolled children into the Children’s Health Insurance Program (CHIP), making it entitled to bonuses it should not receive, according to an audit by the Office of Inspector General (OIG) of the U.S. Department of Health and Human Services.
The audit revealed that the overpayments occurred between 2010 and 2013. During that time, Colorado's CHIP enrollment increased from less than 320,000 to more than 417,000. Colorado included its blind and disabled children in its enrollment figures that counted toward bonus payments. But the OIG said bonus payments should only be applied to children, children of unemployed adults, and children in foster care. The annual overpayments ranged from $8.4 million to $10.4 million, according to the OIG.
OIG regularly issues reports detailing overpayments in the Medicare and Medicaid programs. Last year, it concluded that Texas overpaid providers millions of dollars of meaningful use incentives for the adoption of electronic medical records. In 2013, the OIG noted that investigators in Tennessee were able to claw back more than $181 million in illegal provider payments and obtain more than 100 criminal convictions and civil settlements.
State officials said it complied with “the letter and spirit” of the bonus requirements, and said it had followed CMS' 2009 guidance on the matter.
“Allowing the state agency to include individuals from other categories in its current enrollment counts, when those same categories were not included in the baseline calculations, would result in an artificially inflated estimate of growth in children enrolled in the state’s Medicaid program,” OIG concluded.
- read the OIG report (.pdf)