South Carolina Medicaid Overpaid Hospitals for Some Inpatient Services That Medicare Paid

6957964_lSouth Carolina overpaid some Medicaid inpatient claims from hospitals that had received Medicare payments for the same services. Of the 1,136 overpayments ($2.3 million Federal share) that we reviewed, the hospitals had refunded 532 prior to our audit. However, the hospitals had not refunded the remaining 604. The overpayments were due to the State’s lack of system edits to detect erroneous or incorrect hospital entries in their payment system. As a result, the State agency made Medicaid overpayments to hospitals totaling $1 million ($798,000 Federal share).

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