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Fraud, Abuse, Or Retaliation
Where To Report Waste Fraud, Abuse, Or Retaliation

Colorado Did Not Report and Refund the Correct Federal Share of Medicaid-Related Overpayments for 70 Percent of the State's Medicaid Fraud Control Unit Cases

Submitting OIG: 
Department of Health & Human Services OIG
Date Issued: 
Tuesday, October 25, 2022
Agency Reviewed / Investigated: 
Department of Health & Human Services
Submitting OIG-Specific Report Number: 
A-07-21-02834
Component, if applicable: 
Centers for Medicare & Medicaid Services
Centers for Medicare and Medicaid Services
External entity, if applicable: 
Colorado Dept of Health Care Policy and Finacing
Location(s): 
CO,
United States
Type of Report: 
Audit
Questioned Costs: 
$3,669,738
Funds for Better Use: 
$0
Number of Recommendations: 
4
View Document: 
AttachmentSize
PDF icon 72102834.pdf1.34 MB

Related Open Recommendations

Recommendation Number Recommendation Status Significant Recommendation Additional Details
23-A-07-005.01 Open No
We recommend that the Colorado Department of Health Care Policy and Financing report and refund $3,669,738 (Federal share) in unreported MFCU-determined Medicaid overpayments that related to paid claims and court-ordered awards that have been recovered and collected;
23-A-07-005.02 Open No
We recommend that the Colorado Department of Health Care Policy and Financing determine the value of overpayments, including those related to court-ordered awards, identified after our audit period that have been recovered and collected but not reported; report them on the Form CMS-64; and refund the Federal share of the recovered overpayments and collected court-ordered awards.
23-A-07-005.03 Open No
We recommend that the Colorado Department of Health Care Policy and Financing strengthen policies and procedures to ensure that overpayments are reported correctly and in a timely manner on the Form CMS-64 in accordance with Federal requirements, to include adding instructions on how to report court-ordered awards that have been collected and the timely reporting of these overpayments.
23-A-07-005.04 Open No
We recommend that the Colorado Department of Health Care Policy and Financing strengthen policies and procedures to ensure that MFCU-determined Medicaid overpayments are reported on line 2 of the Form CMS-64.9C1 if recovered or on line 2 of the Form CMS-64.9OFWA if not recovered within timeframes specified by Federal requirements.
Displaying 4 of 4 Recommendations