Review of Illinois' Reporting of Fund Recoveries in the Appeals Process on the Form CMS-64

摘要

Illinois, the Department of Healthcare and Family Services (State agency) administers the Medicaid program. The State agency, through the Illinois Department of Healthcare and Family Services, Office of Inspector General (HFS-OIG), conducted audits of Medicaid providers. In addition, HFS-OIG contracted annually with third parties to conduct audits of Medicaid providers. When State Medicaid audits identified overpayments, HFS-OIG sent letters to the providers identifying the overpayment amounts and providing information on arranging payment, sending additional documentation, or appealing the decision. Our objective was to determine whether the State agency reported Medicaid overpayments that were in the appeals process on the CMS-64 in accordance with Federal requirements.