Colorado's Program Integrity Section Reporting of Medicaid Overpayments
Learn how the AI-generated research projects were createdOverall Conclusion
Colorado did not report and refund the correct Federal share of Medicaid overpayments identified by its Program Integrity Section during Oct 1, 2014 through Dec 31, 2020; 80 of 403 cases contained unreported or incorrectly reported amounts, with late reporting and misused feeder forms indicating gaps in internal controls and procedures.
Source Document
Audit Scope
Period October 1, 2014 through December 31, 2020; review of 403 Medicaid overpayment cases (out of 956 total) with total overpayments of $28,442,635; focus on reporting to CMS via Form CMS-64 and related feeder forms.
Key Findings Summary
Specifically, the State did not report $385,180 ($673,686 Federal share) in Medicaid overpayments for 80 of the 403 cases reviewed, and underreported or did not report portions of Federal share for other cases (e.g., $251,156 ($603,012 Federal share) underreported and $134,024 ($70,674 Federal share) not reported).
In addition, $12,711,166 ($8,465,227 Federal share) reported by the State was not reported in a timely manner.
The State did not calculate or report interest on the Federal share for unreported/late overpayments (not calculated in this audit).
View the Findings tab to see all 6 findings
AI-Assisted
AI Scope Summary
This audit builds on prior reviews by evaluating whether Colorado consistently reports and refunds the correct Federal share of Medicaid overpayments, identifies gaps in reporting forms and timelines, and recommends improvements to policies, procedures, and coordination with CMS to prevent future underreporting and delays.
AI-Generated Insight
The audit reveals significant weaknesses in Colorado's Medicaid overpayment reporting controls, including misapplication of Form CMS-64 feeder forms, late filings, and gaps in tracking and recovering federal shares. Strong corrective action and CMS coordination are required to ensure timely and accurate reporting and refunds, including calculating any owed interest.
Audit Objectives
Determine whether Colorado reported and refunded the correct Federal share of Medicaid overpayments identified by its Program Integrity Section during October 1, 2014, through December 31, 2020.
Audit Findings (6)
Specifically, the State did not report $385,180 ($673,686 Federal share) in Medicaid overpayments for 80 of the 403 cases reviewed, and underreported or did not report portions of Federal share for other cases (e.g., $251,156 ($603,012 Federal share) underreported and $134,024 ($70,674 Federal share) not reported).
In addition, $12,711,166 ($8,465,227 Federal share) reported by the State was not reported in a timely manner.
The State did not calculate or report interest on the Federal share for unreported/late overpayments (not calculated in this audit).
Colorado did not report and refund the correct Federal share of Medicaid overpayments identified by its Program Integrity Section during October 1, 2014, through December 31, 2020.
The State did not report Medicaid overpayments on the correct feeder forms (CMS-64.9C1 for recovered within timeframes and CMS-64.9OFWA for uncollected within timeframes).
The State's policies and procedures were not adequate to ensure timely and correct reporting; staff did not understand correct form usage.
Recommendations (5)
Strengthen policies and procedures to ensure overpayments are reported correctly and in a timely manner on the Form CMS-64.
Update policies and procedures to ensure Medicaid overpayments are reported on the correct feeder forms (CMS-64.9C1 if recovered; CMS-64.9OFWA if not recovered within timeframes).
Report and refund $385,180 ($673,686 Federal share) in unreported Medicaid overpayments that were recovered and collected.
Determine the value of overpayments identified after the audit period that have been recovered but not reported, report them on the Form CMS-64, and refund the Federal share.
Work with CMS to determine the amount of interest, if any, on the Federal share owed, and report that amount.