Sloppiness

The federal Office of the Inspector General has some homework for West Virginia Department of Medical Assistance Services officials, after it discovered the state overpaid almost $300,000 to hospitals receiving Medicaid Electronic Health Record Incentive Program payments. West Virginia officials have acknowledged they overpaid the hospitals cited in the audit, but say the error was a result of failing to confirm data provided by the hospitals with cost reports.

Now, the OIG is asking West Virginia to repay the federal government the $295,962 in overpayments it found in its audit. It is also recommending the state adjust payment calculations to the hospitals in question. Fair enough.

But here is the part that should raise eyebrows in Charleston: The OIG’s audit was of a sampling of only five hospitals. It found overpayments received by three of those five. Therefore, the OIG is asking West Virginia officials to review payments made to all 42 hospitals participating in the program. Again, a reasonable request, given the number of mistakes found in the audit’s scope.

But think for a minute. If three of five hospitals in the sampling were being overpaid, let us carry that to three-fifths of the remaining 37 hospitals also being overpaid. If we round down and say there are 22 more hospitals receiving overpayments; and we use the amount of $295,962 for every three of those hospitals, that is an additional potential $2.17 million that will need to be repaid to the federal government.

State officials are getting into the potential for some serious money to return to Washington, D.C., all because no one bothered to check whether the numbers coming from hospitals were correct. Or, as the OIG rather generously put it:

“The incorrect payment errors occurred because the state agency’s program integrity contractor failed to identify certain errors and inconsistently applied this new program’s complex requirements.”

This is the kind of sloppiness West Virginia literally can no longer afford, and is the latest in an avalanche of examples that prove business as usual in Charleston can no longer be tolerated.