Medicaid: Millions of Dollars Not Recovered From Michigan Blue Cross/Blue Shield.

摘要

This report responds to the request that we review Michigan's efforts to ensure that private insurers are paying claims for Medicaid recipients who have health insurance. Federal law requires state agencies that administer the Medicaid program to make reasonable efforts to identify liable third parties, including health insurers, and seek recovery when they are identified after Medicaid has paid for program services. GAO and others have reported problems that states have encountered in meeting these requirements. Because an estimated 14 percent of the nation's Medicaid recipients have health insurance, unrecovered payments can result in large losses to the Medicaid program. The Committee had received allegations that the Michigan program was not recovering payments from Blue Cross and Blue Shield of Michigan (BC/BS), which has an estimated 60-65 percent of the state health insurance market and insures about 7 percent of Michigan's Medicaid recipients. We sought to determine (1) the nature of any problems that might exist and the amounts involved and (2) the adequacy of state Medicaid agency recovery efforts and federal oversight of those efforts.