Healthcare providers banned from Medicaid may have been reimbursed $213 million in federal money, thanks to a state agency oversight, a government watchdog reported.
Valid identification numbers — identifiers that ensure providers are eligible for Medicaid reimbursements — were missing from 800,000 Colorado claims in 2011, the U.S. Department of Health and Human Services inspector general reported Wednesday.
The state reimbursed the providers $424.4 million for the claims, of which, $213 million was federal money.
"Medicaid claims submitted for reimbursement that do not have [identification numbers] are thus more vulnerable to improper payments," the report said. "In fact, it is possible that the state agency paid claims that had been submitted by federally banned providers."
Federal law requires that Medicaid claims must include valid identification numbers. Providers can be banned for reasons such as committing fraud.
Investigators reported that more than 798,000 of the 2011 claims totaling at least $212.1 million in federal money were missing identification numbers. Another 4,700 claims totaling about half a million dollars in federal money had identification numbers that did not match any provider.
The providers were reimbursed because Colorado's claims processing software didn't alert officials of invalid or missing identification numbers, the inspector general found.