Colorado's Program Integrity Section Reporting of Medicaid Overpayments

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.

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.