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Missouri May Owe Feds $11.5 Million For Improper Medicaid Claims

Adrian Clark | Flickr

The state of Missouri may be required to repay $11.5 million to the federal government, after miscalculating Medicaid payment rates for some case management services to people with developmental disabilities. The findings  were published last week in an audit by the Office of the Inspector General. 

The error meant that providers of those services, such as the St. Louis Office for Developmental Disability Resources, received slightly higher reimbursements for care than allowed by the Centers for Medicare and Medicaid Services. Over a period of three years, payments were about ten percent higher than they would have been under the correct calculations.

The payments were for targeted case management services, which assist individuals with transitioning between care providers, filling out applications and referrals to community-based resources like food pantries, housing and transportation.

Audits finding Medicaid miscalculations are not uncommon, according to healthcare policy professor Kathleen Gillespie of St. Louis University. But Gillespie said providers may have difficulty adjusting to the lower rates.

“Clearly, it’ll be harder to provide services if the reimbursement rate is lower than it used to be,” Gillespie said. “It’s unfortunate that they miscalculated.”

The Missouri Department of Health and Human Services is responsible for calculating the reimbursement rate, which is adjusted annually. Between July of 2010 and June of 2013, the audit showed it claimed approximately $17.4 million in overpayments: $11.5 million from the federal government and $5.9 million from the state of Missouri.

A spokesperson for the Missouri DHHS said in an email that the state is reviewing the report, but declined further comment. The agency has until November 27 to respond to the audit. Ultimately, the Centers for Medicare and Medicaid Services will determine how and when it will request repayment.