State May Be Letting Millions Slip Away

The state Health and Welfare Department may be forgoing millions of dollars because it is not settling accounts with out-of-state hospitals for care given poor people.

In a report issued on Monday, legislative auditors found that since 1987 there were 193 cases involving out-of-state providers that qualified for a determination of whether too much or too little was paid for indigent health care. Those cases involved over $77 million.

During that period, however, only six cases worth $2 million were settled, and out of that the state recovered nearly $316,000 in what amounted to overpayments, the audit found.

That was a recovery rate of 16 percent, suggesting that as much as $12 million could be recovered if the rest of the cases were pressed to settlement.

Department officials acknowledged the backlog of cases to be reconciled and said it was trying to hire a Medicaid reimbursement policy specialist.