Medicaid Audit Reveals Billions in Nursing Home Overpayment

According to a recent audit the Department of Health in one state has estimated it overpaid nursing homes by an estimated $42 million in Medicaid reimbursements over a period of 44-months.  The state says that the over-payments have occurred because many care providers are not collecting money from their clients’ income sources as required, and local governments are failing to enforce that requirement.

Localities are responsible to determine the Net Available Monthly Income of Medicaid recipients on an ongoing basis and must provide the information to the Department of Health, which processes nursing home provider claims for Medicaid reimbursement. However, the way that the system is structured, presents a high risk for exploitation because there is a financial incentive for providers to forgo billing to avoid an offset to their Medicaid payment.

According to researchers, it is likely that Medicaid has overpaid millions of dollars more than the audit shows because a previous computer system that predated the current system (established in 2005) also reportedly did not properly process required offsets triggered by the Net Available Monthly Income. For more, read the story.


Robert W. Carter, Jr. is a Virginia attorney whose law practice is dedicated to protecting the rights of the victims of nursing home and assisted living neglect and abuse in Richmond, Roanoke, Norfolk, Lynchburg, Danville, Charlottesville, and across Virginia.

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