CAP for Finding: 2022-001 DATE: November 16, 2022 TO: Lisa Kasel, Assistant Financial Audit Director Legislative Audit Bureau FROM: Barry Kasten, Director Bureau of Fiscal Services Department of Health Services SUBJECT: Corrective Action Plan ? Medical Assistance Program Third-Party Liability Depart...
CAP for Finding: 2022-001 DATE: November 16, 2022 TO: Lisa Kasel, Assistant Financial Audit Director Legislative Audit Bureau FROM: Barry Kasten, Director Bureau of Fiscal Services Department of Health Services SUBJECT: Corrective Action Plan ? Medical Assistance Program Third-Party Liability Department staff has reviewed the Legislative Audit Bureau?s (LAB) interim audit memo for Finding 2022-001: Medical Assistance Program Third-Party Liability. This is the department?s Corrective Action Plan. ? Recommendation (2022-001): Medical Assistance Program Third-Party Liability We recommend the Wisconsin Department of Health Services: ? Review and update the Medicaid Management Information System cost avoidance rules to properly identify and deny payment for claims that may be covered by third-party insurers. Wisconsin Department of Health Services Planned Corrective Action: DHS has completed an assessment of Medicaid Management Information System (MMIS) cost avoidance rules and will implement changes by December 31, 2022, necessary to properly identify and deny outpatient services when a participant is enrolled in Medicare or other third-party insurance at the time the service was provided. We recommend the Wisconsin Department of Health Services: ? Identify payments made during FY 2021-22 that may have been improper due to inaccurate cost avoidance rules and seek to recover these amounts; ? Return to the federal government recovered payment that may have been improper; and Wisconsin Department of Health Services Planned Corrective Action: DHS will attempt to recover $1,956 in improper payments for outpatient services not properly identified and denied under cost avoidance rules in MMIS by December 31, 2022, and return to the federal government the estimated federal share of $1,293. DHS will complete an assessment and identify paid claims by March 31, 2023, where cost avoidance rules were not appropriately applied for outpatient services when a participant was enrolled in Medicare or other third-party insurance with a date of service after July 1, 2021, and return to the federal government recovered payments that were improper. We recommend the Wisconsin Department of Health Services: ? Perform an assessment and implement additional procedures to review changes to cost avoidance rules in the future. Wisconsin Department of Health Services Planned Corrective Action: DHS will implement processes and procedures by December 31, 2022, for conducting production validation on any configuration changes impacting cost avoidance rules. Anticipated Completion Date: March 31, 2023 Person responsible for corrective action: Nick Havens, Director Bureau of System Management, Division of Medicaid Services Nicholas.Havens@dhs.wisconsin.gov