Millions of dollars in Nevada medical overpayments could be due to fraud
CARSON CITY — The state Department of Health and Human Services overpaid between $3.5 million and $4.3 million to providers for individuals with intellectual disabilities, a state audit has found.
The Legislative Commission’s Audit Subcommittee heard the findings on Wednesday.
The audit found the overpayments could be possible provider fraud and that some instances may be unintentional errors. State auditors detected the overpaid dollars by comparing records of hours billed to the state against the providers’ own logs and payroll records of staff. In some cases, auditors found the providers billed for more hours than actually worked.
The audit reviewed records in 2015. The bulk of the overpayments were tied to 24-hour care homes.
In one instance, a provider billed for about 1,400 hours of staff time, an overbilling of about 200 hours.
State auditors made a variety of recommendations that include reviewing more billings, written policies and procedures for billings and a graduated sanctions system that can terminate providers who overbill.
“We’ve got to get it right and these are also services where we have historically had waiting lists,” said subcommittee chairman Sen. Ben Kieckhefer, R-Reno. “We’ll keep an eye on it and get it right.”
Lawmakers also expressed concerns about the breadth of the overbilling uncovered in the audit.
“That’s like me delivering a thousand cows and saying I gave you 1,500,” said senator and rancher Pete Goicoechea, R-Eureka. “It doesn’t work.”
A planned information technology system also will help safeguard against similar problems in the future, said Edward Ableser, administrator of the state department’s Aging and Disability Services Division. There also are plans to replace the hourly billing system with a daily rate, he said.
The programs are paid by state dollars and Medicaid funding.
For the next steps, Nevada’s Medicaid Surveillance and Utilization Review Section Unit, which focuses on fraud and abuse, will review a larger sample of records and work on recouping dollars from providers who overbilled the state.
Cases of potential fraud will be forward to the Attorney General’s office for further investigation.
Contact Ben Botkin at bbotkin@reviewjournal.com or 775-461-3820. Follow @BenBotkin1 on Twitter.
