weather icon Clear

Nevada had $60M in Medicaid overpayments, audit finds

CARSON CITY — Nevada’s Medicaid program overpaid health care providers by an estimated $60 million in fiscal year 2018, an audit found.

The overpayments stemmed from undetected or unreported wage increases for Medicaid recipients, increases that either would have reduced the benefit payments or terminated them from the program altogether, legislative auditors told state lawmakers on Tuesday.

Similar wage reporting and detection issues also led to about $9.5 million in overpayments from the Supplemental Nutrition Assistance Program, formerly called food stamps.

The nearly $70 million in combined overpayments were considered “conservative” estimates, according to the audit of the Division of Welfare and Supportive Services, and actual amounts “could potentially be much higher.”

The state’s total Medicaid budget is $8.5 billion for the current two-year budgeting cycle, with $6.7 billion of that coming from federal funding.

Auditors analyzed quarterly wage data for 50 households that receive Medicaid benefits from the state’s Employment Security Division. Of those households, auditors found 11 that had unreported income increases for one or more quarter that resulted in $54,321 in overpayments. Auditors also found four households with incomes that were less than reported.

Auditors projected those findings over the 417,000 households that receive Medicaid benefits in Nevada and estimated that the state made $59.8 million in Medicaid payments for ineligible recipients, the audit said.

Unless Medicaid recipients report their income changes on time, “most of these improper payments are not preventable by the division using available wage information,” the audit said.

Medicaid recipients are supposed to report any income changes by the fifth day of the month or within 10 days of the change so that the state can re-evaluate benefits and eligibility. Otherwise, Medicaid patients report their household income during their annual renewal periods.

Chief Deputy Legislative Auditor Shannon Ryan said that utilizing quarterly wage data could help the state identify eligibility changes between those renewal periods.

The division identified 3,246 cases of overpayments in both Medicaid and SNAP programs in 2018, according to spokeswoman Julie Balderson. The division was able to establish roughly $3.5 million in overpayments to Medicaid from those cases, and have recovered $1.85 million so far, she added.

Assemblywoman Maggie Carlton, D-Las Vegas, said the reason the Legislature settled on the one-year eligibility window was due to the “ebb and flow” of pay for many who receive Medicaid benefits.

“Some folks will do well at one end of the year, but maybe not so well at the other end of the year,” Carlton said.

Carlton said she also has concerns about setting up systems to recoup that money from the recipients, because that money never goes directly to the recipients, but rather to hospitals and doctors.

“We penalize the recipient when they never received the dollars. They just received health care,” Carlton said.

The audit made eight recommendations, including that the division use quarterly wage information to better check eligibility and improve the policies and systems that deal with notifications about eligibility, all of which were accepted by the agency.

Don't miss the big stories. Like us on Facebook.
Sisolak submitted a formal request to President Donald Trump for a major disaster declaration

Gov. Steve Sisolak on Tuesday submitted a formal request to President Donald Trump for a Major Disaster Declaration for the State of Nevada. If approved, this declaration will provide additional federal assistance and emergency protective measures available under the nationwide emergency proclamation.

Sisolak extends ‘Stay at Home’ order through April

Gov. Steve Sisolak on Wednesday formally issued a “Stay at Home” directive for Nevadans and extended the nonessential business, gaming and school closures and all other directives issued under the Emergency Declaration to April 30.

April 1 is census day

Today is “Census Day,” and though minds all around America are occupied by concerns regarding the novel coronavirus, the U.S. Census Bureau is continuing its efforts to conduct this constitutionally-mandated decennial process. Census officials are urging everyone residing in the U.S., regardless of citizenship, to make sure they and their families are included in this most important count.

Man accused of making bomb threat arrested

When a Pahrump resident could not get logged on to his home computer, he decided to make a phone call to Valley Electric Association at approximately 9 p.m., on Tuesday, March 24.

Deputy recovering from injuries

A Nye County Sheriff’s Office detective is recovering after being shot while investigating a stabbing.

Fire extinguishes self but claims life of Pahrump man

Pahrump Valley Fire and Rescue Services crews responded to a series of structure fires within the past week, with at least one fatality reported.

Serenity Health partnering with Nye for COVID-19 testing

Testing for the novel coronavirus COVID-19 has been a point of major contention in recent weeks as states grapple to keep pace with demand and though testing supplies are being stretched thin, Serenity Health, through its lab, has managed to secure enough kits to partner with Nye County to conduct drive-up testing in three local communities.

Fish and chips restaurant open during health crisis

A new local business has moved into Pahrump hoping to bring the fresh catch of the sea to the residents of Pahrump.

Chili Cook Off in Pahrump brings in $5k

The 8th Annual Silver State Chili Cook Off took over Petrack Park March 14 and 15, drawing people from all walks of life for two days of chili tasting and community fun, with all of the proceeds earmarked for one of the Pahrump Valley’s well-known nonprofit organizations, the Nevada Outreach Training Organization and its No to Abuse program.