Industry News

GAO Releases a Report on States’ Reporting of Overpayments.

Lisa Shuman | December 2013

In a recent study, the Government Accountability Office (GAO) assessed states’ efforts to recover and report Medicaid overpayments identified by federal audits, and examined the Centers for Medicare & Medicaid Services (CMS) review of state reporting.  The GAO compared overpayment and recovery data from all states with an identified overpayment with CMS data.  The GAO also reviewed relevant laws, regulations, and CMS guidances, and interviewed CMS and state officials.

The GAO found that states recovered $9.8 million in Medicaid overpayments; however, states did not clearly report the overpayments and returns of the federal share to CMS.  States reported the return of the federal share for $12.4 million, instead of reporting $13.3 million in net overpayments.  Further, states reported $6.6 million of the $12.4 million correctly on the CMS-64 form, but reported the remaining $5.8 million on the incorrect line of the CMS-64 form.  The GAO recommended that CMS enhance efforts to ensure that states are clearly reporting overpayments identified by federal audits in the correct location of the CMS-64 form.  The Department of Health and Human Services agreed with this recommendation.

The GAO report on State Recovery and Identification of Overpayments is available at:

Government Accountability Office.  “CMS Should Ensure That States Clearly Report Overpayments.”  GAO-14-25.  6 Dec. 2013.

About the Author

Ms. Shuman assists health care organizations to develop, implement and evaluate their compliance programs and HIPAA privacy programs. Ms. Shuman specializes in our firm’s HIPAA Privacy services, including leading privacy investigations, breach risk assessments, breach notification letters, breach reporting to the Office for Civil Rights and corrective actions plans. She specializes in serving as Interim Privacy Officer for large health care systems, managed care organizations, comprehensive cancer center and health care business associate.