Sneak Preview: Financial Statement Errors Cost Ga. Agency $90M

September 19, 2013 | By Jerry Ashworth | Post a Comment

xgran_bookshot(The following was excerpted from an article in the Federal Grants Management Handbook.) States that seek federal Medicaid reimbursement should be aware of the program’s two-year reimbursement deadline, and should not rely on the argument that making an “erroneous credit” is an acceptable reason to seek claims after this deadline.

The Department of Health and Human Services Departmental Appeals Board recently affirmed the Centers for Medicare and Medicaid’s disallowance of more than $90 million in federal Medicaid funding sought by the Georgia Department of Community Health. Georgia had sought the $90 million on a Quarterly Medicaid Statement of Expenditures (QSE) for the quarter ending on June 30, 2009, but CMS disallowed the request because it deemed it was not submitted in a timely manner under Medicaid law.

The federal government may reimburse Medicaid program expenses only if a state files claims within two years after the quarter in which the expenditures are made. The two-year limit is intended to ensure that states submit final reimbursement requests in a timely fashion so that HHS can plan its budget.

Each quarter, states are required to submit to CMS a QSE (Form CMS-64). The QSE is an accounting of actual recorded expenditures that a state believes is entitled to Medicaid reimbursement for a particular quarter. The QSE consists of several schedules on which a state reports expenditures made by its Medicaid program. While the QSE base schedule identifies the amount of expenditures that are made during the current quarter, other schedules show expenditure amounts that constitute adjustments, either overpayments or underpayments, related to prior periods.

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