States Face Ongoing Challenges in Meeting Third Party Liability Requirements for Ensuring That Medicaid Functions as the Payer of Last Resort

Submitting OIG:

Department of Health & Human Services OIG

Date Issued:

Friday, October 20, 2023

Agency Reviewed / Investigated:

Department of Health & Human Services

Submitting OIG-Specific Report Number:

A-05-21-00013

Component, if applicable:

Centers for Medicare & Medicaid Services

Centers for Medicare and Medicaid Services

Location(s):

United States

Type of Report:

Audit

Questioned Costs:

$1,245,924

Funds for Better Use:

Number of Recommendations:

Report updated under NDAA 5274:

View Document:

Attachment	Size
52100013.pdf	3.34 MB

Recommendation Number	Recommendation Status	Significant Recommendation
24-A-05-006.01	Open	No
We recommend that the Centers for Medicare & Medicaid Services use the information we obtained from States about the challenges they are still encountering and develop an action plan for helping States more easily identify liable third parties and recover Medicaid payments.
24-A-05-006.02	Open	No
We recommend that the Centers for Medicare & Medicaid Services work with States, as appropriate, to encourage better cooperation from third parties that routinely resist States' TPL identification and recovery efforts.
24-A-05-006.03	Open	No
We recommend that the Centers for Medicare & Medicaid Services, for the four States we identified as not having fully complied with the DRA's TPL provisions, verify whether the States have since come into compliance; and pursue corrective actions for States that have not fully complied.
24-A-05-006.04	Open	No
We recommend that the Centers for Medicare & Medicaid Services verify whether Virginia has refunded the $1.25 million Federal share of the Medicaid TPL collections underreported during two fiscal quarters and, if not, require Virginia to refund any remaining amount owed.
24-A-05-006.05	Open	No
We recommend that the Centers for Medicare & Medicaid Services provide guidance to States to assist them with developing processes that improve the reporting of Medicaid TPL amounts on the form 64.9A.
24-A-05-006.06	Open	No
We recommend that the Centers for Medicare & Medicaid Services ensure that States have current instructions on completing the form 64.9A.
24-A-05-006.07	Open	No
We recommend that the Centers for Medicare & Medicaid Services ensure that States correctly report TPL amounts on the form 64.9A.
24-A-05-006.08	Open	No
We recommend that the Centers for Medicare & Medicaid Services remove or disable lines from the form 64.9A that States are supposed to leave blank.

Recommendation Number

Recommendation Status

Significant Recommendation

Additional Details

24-A-05-006.01

Open

We recommend that the Centers for Medicare & Medicaid Services use the information we obtained from States about the challenges they are still encountering and develop an action plan for helping States more easily identify liable third parties and recover Medicaid payments.

24-A-05-006.02

Open

We recommend that the Centers for Medicare & Medicaid Services work with States, as appropriate, to encourage better cooperation from third parties that routinely resist States' TPL identification and recovery efforts.

24-A-05-006.03

Open