Health
An Audit Report on the Department of Health's Medicaid Contract With
National Heritage Insurance Company
July 2000
Report Number 00-036
Overall Conclusion
The Department of Health (Department) has not held National Heritage Insurance Company (NHIC) accountable for processing Medicaid claims accurately, for enrolling providers properly, or for completing a new Medicaid Management Information System on time. NHIC processed over $3.5 billion in Medicaid expenditures during fiscal year 1999.
Key Facts and Findings
- The Department has not had adequate controls to detect and correct problems with the claims payment process. For example, invalid provider identification information on paid claims resulted in approximately $35 million in improper payments over the life of the contract.
- The Department has been slow to address problems with the provider enrollment process- problems it has known about since June 1998. In May 2000, 205 active dental providers were without a valid license status.
- The Department's contract for Compass 21, the new claims processing system, did not base payments to NHIC on the completion of processes or activities. The Department has paid NHIC $69 million, the full balance of the contract. However, Compass 21 will not be implemented until December 2001-25 months after the original target date.
Contact the SAO about this report.
Download the Acrobat version of this report.
HTML Equivalent (utilizing Adobe's PDF Conversion by Simple Form).