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HRD-85-47 1 (1985-03-20)

handle is hein.gao/gaobabnti0001 and id is 1 raw text is: UNITED STATES GENERAL ACCOUNTING OFFICE WASHINGTON, D.C. 20548 HUMAN RESOURCES DIVISION March 20, 1985 Carolyne K. Davis, Ph.D. Administrator, Health Care Financing Administration Department of Health and Human Services 127880 Dear Dr. Davis: Subject: Medicaid Overpaymient-s Made to Hawaii Should Be Disallowed (GAO/HRD-85-47) During a review of state Medicaid operations, we found that Hawaii was not always following federal statutory requirements that other insurance available to Medicaid recipients be used before Medicaid. Medicaid law requires the states, which administer payments under the Medicaid program, tc take all reasonable measures to ascqrtain the legal liability of third parties to pay for health services provided to recipients and to assure that such liable parties pay rather than Medicaid. The law also prohibits the use of federal funds for paying claims for which a third party would have been liable except for an exclusion of coverage for persons eligible for Medicaid. However, we found that Hawaii, under its no-fault motor vehicle insurance law, had allowed insurers to exclude medical coverage for Medicaid recipients in certain circumstances such as when recipients were injured while driving their vehicles. In those circumstances when coverage for Medicaid recipients was not excluded, Hawaii was not actively pursuing collections from the no-fault insurers. We estimate that during fiscal years 1982-84, Hawaii paid about $1.4 million in federal funds for health services that it would not have paid if it had followed Medicaid's third party liability provisions. BACKGROUND The Medicaid program, authorized by title XIX of the Social Security Act (42 U.S.C. 1396), is a federally aided, state- administered medical assistance program for low-income people. The Department of Health and Human Services (HHS) has overall responsibility at the federal level for administering Medicaid. Within HHS, the Health Care Financing Administration (HCFA) is responsible for developing program policies, setting standards, and ensuring compliance with federal Medicaid legislation and regulations. (106269)

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