Providers pay for Medicaid's mistake

Glitch triggers overpayments on crossover claims
Friday, January 25, 2013

TALLAHASSEE, Fla. – Providers here in December got hit with Medicaid letters seeking to recoup five years of overpayments.

“Medicaid is saying, ‘We accidentally paid you (money) that we shouldn’t have and we want that back,” said Rob Brant, an adviser to the Florida Alliance of Home Care Services (FAHCS).

What happened is this: In cases where Medicare patients have Medicaid as a secondary insurance, Medicaid makes a payment when its fee schedule amount is more than Medicare’s; if it’s less, they pay nothing. But in this case, a glitch in the system triggered Medicaid payments. The average recoupment, according to FAHCS, is $20,000, and providers have reported requests reaching as far back as 2008. 

Because the claims should never have been paid in the first place, providers have no recourse.

“They say the supplier should have known and compared the fee schedules themselves, and then refunded the money of their own volition,” said Sylvia Toscano, owner of Professional Medical Administrators.

Medicaid has told providers they will have six months to repay the claims, in most cases with Medicaid recouping a small percentage of future claims.

“If you have to repay $100,000 in the next six months, you are not going to receive a penny and you’ll feel it,” said Jack Marquez, owner of Cobra Medical in Doral.