HHS Audit Finds Pennsylvania Overcharged Medicaid Millions for Nursing Home Care

An HHS inspector general audit of Pennsylvania's Medicaid program found that the state has "improperly" billed the federal government more than $89 million for Medicaid reimbursements, the Philadelphia Inquirer reports. According to the audit, between 1997 and 2000, Pennsylvania received $89 million more in Medicaid funds than it was not owed and may have received an extra $65 million between 1990 and 1997. HHS' inspector general is now recommending that Pennsylvania stop requesting payments that it is not entitled to and refund the $89 million. In addition, the report advocated a "close review" of the $65 million to determine if it should be returned to the federal government. The Inquirer reports that Pennsylvania received the extra funding by seeking reimbursements for expenditures that were never made. Although Pennsylvania law requires counties to contribute 10% of the state's share of Medicaid costs at county-owned nursing facilities, the state waived the requirement and the counties do not actually contribute to the program. However, the state files for federal reimbursement as if the counties had paid their share, and then receives "inflated" payments that go into the state's general fund. Jay Pagni, a spokesperson for the state Department of Public Welfare, which administers Medicaid, said the agency would try to find "some sort of resolution" with HHS. He added that the federal government had been "aware" of the state's billing practices, saying, "Up until this point, there has not been an issue" (Nicholas, Philadelphia Inquirer, 6/13).