Washington State Claimed Federal Medicaid Reimbursement for Inpatient Hospital Services Related to Treating Provider-Preventable Conditions 

The Washington State Health Care Authority (State agency) claimed Federal Medicaid reimbursement for inpatient hospital services related to treating certain provider-preventable conditions (PPCs). For the period July 1, 2012, through December 31, 2013, we identified 463 claims totaling $18.3 million ($10.8 million Federal share) that contained PPCs and (1) a present-on-admission indicator code (POA code) indicating that the condition was not present on admission, (2) a POA code indicating that the documentation in the patient's medical record was insufficient to determine whether the condition was present on admission, or (3) no POA code.