Department of Health and Human Servces

OFFICE OF

INSPECTOR GENERAL

MEDICAID CREDIT BALANCES 
NURSING FACILITY PATIENT ACCOUNTS 
.. stRVICtn 
Richard P. Kusserow 
INSPECfOR GENERA 
'0 
lfcl.a  OEI-07-90-011  EXECUTIVE  SUMMAR 

PUROSE 
The purpose of this national inspection is to determine the dollar amount of Medicaid 
credit balances that exist at Medicaid-participating nursing facilities, and the time used 
by nursing facilities and State Medicaid agencies in reporting and adjusting credit 
balances. 
BACKGROUN 
Whenever a Medicaid payment is made to a provider (e.  , nursing facility) in excess 
of the amount of payment that is due, a credit balance is created. The nursing 
facilities, as well as the State Medicaid agencies, have a responsibility to resolve these 
credit balances. 
In a previous orG review of hospitals conducted in 1989, we found substantial 
amounts of Medicaid credit balances in hospitals. The Medicaid credit balances in the 
five sampled States projected to a total of $16 milion ($8 970 198 federal share). The 
review allowed the Health Care Financing Administration (HCFA) to pursue and 
recover most of the overpayments. This earlier review suggested a potential also for 
Medicaid credit balances in nursing facilities nationwide. 
METHODOLOGY 
We selected a random sample of 50 nursing facilties in two stages. In the first stage 
five States were sampled. Subsequently, 10 nursing facilities were sampled within each 
State for an on-site examination of patient account records. 
We requested the 50 nursing facilties to provide a listing of all credit balances as of 
March 31, 1990. We determed the existence of an actual credit balance based upon 
a review of the patient ledgers maintained at the facilty. Our review determined the 
amount of the credit balance, the date the nursing facilty notifed the State agency of 
the existence of the credit balance, and the length of time it took the State agency to 
adjust the amount of the credit balance. 
FIINGS 
Projecte Medaid Cred Balaes  We estimate nationwide that 
are Substantl 
overdue credit balances could be as much as $32 miion ($18 miion 
federal share) as 
of March 31, 1990. 
Cred Balaes Are Not Report  Ten milion dollars in identified Medicaid 
Tily 
credit balances were not reported after 1 year had elapsed (as of March 31
, 1990).  State Medaid Agen Are Not Adjustig Cred  Fifty-six percent of 
Balances Tunly 
the Medicaid credit balances were not adjusted by the State Medicaid agencies within 
facilities. 
60 days of notice by the nursing 
RECOMMATIONS 
The HCF A Should: 
Encourage State Medicaid Agencies to Take Action to Adjust Credit Balances; 
Require State Medicaid Agencies to Timely Process Adjustment of Credit 
Balances; 
Work With State Medicaid Agencies to Increase the Awareness of Program 
Providers to Timely Identify and Report Credit Balances; and 
Seek Legislation to Penalie Providers which Do Not Timely Report Credit 
Balances. 
COMMNf 
AGENCY 
The HCF A concurred with our recommendations to encourage State Medicaid 
balances and to require State agencies to 
agencies to take action to adjust credit 
process adjustments in a timely manner. The HCF A identified actions it is taking 
The HCF A also agreed with our overall recommendation to work 
towards these ends. 
with State Medicaid agencies to increase the awareness of program providers to 
in a timely manner, and identifed actions it is 
identif and report credit balances 
takg to address this. 
However, HCF A disagreed with our recommendation to penalize providers who do 
not timely report credit balances because they deal priarily with States rather than 
with individual providers. We have elected to retain this recommendation since 
believe that a penalty placed on program providers would be a potent incentive to 
report credit balances, and there are ways HCF A can achieve this through the States. 
Finally, the HCF A questioned the accuracy of our savigs estimate. While we agree 
at our estimate has a wide confdence interval, there is no doubt that the problem of 
credit balances is serious and warrants enhanced action to collect them.   .ediwnoitan seitlicaf gnisrun ni secnalab tiderc diacideM rof laitnetop a
detseggus weiver shT .derrucco ecnalab eht etad eht fo syad 54 ihtiw ecnalab tiderc
 a fo noitacifiton ekam ot meht elbane dluohs serudecorp 'slatipsoh eht taht dnuof
 GIO ehT
 .lla ta secnalab tiderc gnitroper ton ro ylemit secnalab tiderc gnitroper
ton erew slatipsoh eht taht detacidni osla troper ehT .)erahs laredef 376 366 02$(
 890 401 43$ sa hcum sa lauqe dluoc secnalab tiderc diacideM detcejorp eht
 setatS lla ni detsixe smelborp ramis fI .)erahs laredef 891 079 8$( 769 963 61$ erew
 deweiver
 setatS evif eht ni secnalab tiderc detcejorp taht deton )07400-88-70-IEO#(
troper lanoitan GIO na ,9891 hcraM nI .secnalab tiderc egral deifitnedi
 stnuocca tneitapni latipsoh ni secnalab tiderc diacideM fo noitcepsni GIO roirp A
 .syad 06 nihtiw secnalab tiderc eht fo tnuoma eht ni stnemyap
ytlicaf gnisrun
 erutuf tsujda ot tnega lacsif/ycnega diacideM etatS eht seriuqer
)272-99 waL cilbuP( 5891 fo tcA noitalicnoceR tegduB subinmO detadilosnoC
 eht ,yltneuqesbuS .)d( 3091 noitceS ,tcA ytiruceS laicoS eht htiw ecnadrocca
 ni secnalab tiderc fo ycnega diacideM etatS eht fiton tsum seitlicaf gnisrun
eht ,
tsixe ton seod emarf emit lamrof a hguoht nevE .seicnega diacideM etatS eht dna
 seitilicaf gnisrun eht htiw tser seitlibisnopser niatrec ,detaerc era secnalab tiderc nehW
.
 ecnalab tiderc eht fo erahs laredef eht
 dellac si sihT .srallod diacideM etatS hctam ro tsissa ot desu tnemnrevog laredef eht
morf seinom ,srallod noitapicitrap laicnanif laredef era seinom eseht fo erom ro flah
tsael ta ,
oslA .margorp diacideM etatS taht ot kcab eud era seinom dna stsixe ecnalab
tiderc a ,tnuoma tnemyap tcerroc eht fo ssecxe ni si tnemyap eht snosaer suoirav
rof ,
dna redivorp diacideM a ot edam si secvres rof tnemyap a hcus revenehW .erac
 lacidem fo level taht gnideen sa snaicisyhp yb defitrec stneitap rof seitlicaf gnisrun
 elbigile ot stnemyap rof sedivorp )A()31()a( 3091 noitceS ,tcA ytiruceS laicoS ehT
 NUORGKCAB
 .secnalab
 tiderc gnitsujda dna gnitroper ni seicnega diacideM etatS dna seitlicaf gnisrun yb
 desu emit eht dna ,seitlicaf gnisrun gnitapicitrap-diacideM ta tsixe taht secnalab tiderc
 diacideM fo tnuoma rallod eht enimreted ot si noitcepsni lanoitan siht fo esoprup ehT
 ESORUP
N
 OITCUDORTNI  .seicnega diacideM etatS etairporppa ot secnalab tiderc esoht
 detroper ton dah lits seitlicaf gnisrun hcihw denmreted osla eW .secnalab tiderc
 eht fo noitisopsid tnerruc eht dna stnuoma rallod irev ot demrofrep saw weiver
 pu-wollof shT .stisiv etis ruo fo emit eht ta secnalab tiderc gnidnatstuo dah hcihw
 seitlicaf gnisrun eht la fo retal shtnom lareves weiver tneuqesbus a detcudnoc eW
 .ecnalab tiderc eht fo tnuoma eht rof stnemyap sti tsujda ot ycnega diacideM
 etatS eht koot ti emit fo htgnel eht dna ,ecnalab tiderc eht fo ecnetsixe eht fo ycnega
 diacideM etatS eht yfiton ot ytlicaf gnisrun eht koot ti emit fo doirep eht ,ecnalab
 tiderc eht fo tnuoma eht denimreted weiver ruO .tnuoma ecnalab tiderc dna ecnalab
 tiderc hcae fo ecnetsixe eht irev ot seitilicaf eht detseuqer ew ,secnalab tiderc eht fo
 ytidilav erusne oT .ytilicaf eht ta deniatniam noitatnemucod rehto dna sregdel tneitap
 eht fo weiver a nopu desab ecnalab tiderc lautca na fo ecnetsixe eht denimreted eW
 .denimaxe erew 0991
 13 hcraM fo sa secnalab tneitap lla ,ytilicaf eht yb deifitnedi secnalab tiderc on erew
 ereht fI .weiver ruo rof 0991 ,13 hcraM fo sa secnalab tiderc diacideM gnidnatstuo
 fo sgnitsil htiw GIO eht edivorp ot elpmas eht ni ytilicaf gnisrun hcae detseuqer eW
 .seitilicaf gnisrun 94 fo latot
 a gnikam ,edam saw tisiv etis ruo emit eht ta ,revewoh ,ssenisub fo tuo saw ytlicaf
 gnisrun enO .weiver rof nesohc erew seitlicaf gnisrun 01 ,etatS hcae nI .detceles
 saw etatS hcae nihtiw seitlicaf gnisrun fo elpmas modnar elpmis a ,egats dnoces eht nI
 .nisnocsiW dna ,ainavlysnneP
 iruossiM ,adirolF ,anrofilaC :era setatS esehT .ezis ot etanoitroporp ytlibaborp
 htiw egats tsif eht ni nesohc erew setatS erehw detceles saw elpmas retsulc egats
 owt A .dohtem narhcoC ,yltraH ,oaR deifidom a gnisu seitlicaf gnisrun gnitapicitrap
-diacideM lla fo esrevinu eht morf seitilicaf gnisrun fo elpmas modnar a detceles eW
 YGOLODOHTEM  enimreted ot ssecorp noitacirev ecnalab tiderc tnegnirts erom a hguorht og tsum
 seitlicaf gnisrun eht ,syad 081 ihtiw secnalab tiderc eht evloser ton seod etatS eht fi
 ,etatS taht nI .secnalab tiderc diacideM evloser dna troper ylemit ot evitnecni ycnega
 diacideM etatS dehsilbatse na ereht saw )ainavlysnneP( deweiver etatS eno ylno nI
 .retal shtnom 6 revo
 gnidnatstuo deniamer weiver etis-no ruo fo emit eht ta gnidnatstuo secnalab tiderc
 eht fo )802 fo 791( tnecrep 59 taht denimreted ew ,weiver pu-wollof ruo fo rap sA
 C xidneppA  eeSi  seicnega
 diacideM etatS eht ot detroper erew secnalab tiderc eht fo )614 fo 802( flah ylnO
 .snoitarepo evitartsinimda
 dna ssenisub rehto naht ytiroirp ressel fo si secnalab tiderc givloseR
 .secnalab tibed htiw denrecnoc ylno era eW
 :erew seitilicaf gnisrun ta ffats morf
 laciyt
 stnemmoc  ,ylemit detroper ton erew secnalab tiderc eseht yhw deksa nehW
B xidneppA  eeSi  )erahs laredef noilim 6.5$( noiim 01$ si secnalab
 tiderc eseht rof noitcejorp lanoitan ehT .despale dah raey 1 retfa detroper neeb
 ton dah )802( seicnega diacideM etatS eht ot kcab eud secnalab tiderc eht fo flah-enO
 .noitinifed ruo ot gnidrocca ,ylemit detroper
 erew )614 eht fo 37( htfif-eno naht sseL .despale dah raey 1 erofeb tub ,syad 54 retfa
 detroper erew elpmas ruo ni secnalab tiderc 614 eht fo 531 taht dnuof eW .seicnega
 diacideM etatS eht ot secnalab tiderc gnitroper rof emarf emit elbanosaer a si
 syad 54 eveileb ew ,secnalab tiderc troper ot sdrawretfa syad 51 gniwolla dna ylhtnom
 secnalab elicnocer yeht taht lennosrep ytilicaf gnisrun morf noitamroni nopu desaB
 ylnuT tropeR toN erA secnalaB derC
 .syad 54 retfa gnidnatstuo saw ti fi eudrevo sa ecnalab a eifed ew ,gnidnif
 txen eht ni dessucsid sA  xidneppA eeSi)erahs laredef noilim 81$( yllanoitan
 nollim 23$ sa hcum sa eb dluoc margorp diacideM eht ot secnalab tiderc detcejorp
 eht ,setatS rehto eht ni tsixe setatS evif eht ot evitaler snoitidnoc lla gnimussA .)erahs
 laredef noim 4$( nollim 8$ yletamixorppa fo setatS evif eht ni eudrevo secnalab
 tiderc detamitse latot ni detluser etatS hcae ni seitilicaf gnisrun gnitapicitrap-diacideM
 lla ot etatS delpmas hcae rof secnalab tiderc diacideM fo tnuoma eht gnitcejorP
 ltnatsbuS era secnalaB derC diadeM tcejorP
S
 GNIDNIF  .5891 fo tcA noitailicnoceR tegduB subnmO
 detadilosnoC eht fo noisivorp yad-06 eht htiw ecnailpmoc ni syawla ton erew seicnega
 diacideM. etatS eht ,secnatsni suoirav nI .tC xidneppA eeS  
ytlicaf gnisrun eht
 yb eciton fo syad 06 ihtiw seicnega diacideM etatS eht yb detsujda ton erew detroper
 secnalab tiderc diacideM eht fo )802 fo 611( tnecrep 65 taht dewohs weiver ehT
 yliT secnalaB derC gsujdA toN erA negA diadeM etatS
 .ylemit detroper neeb dah stiderc eht fi naht sruoh fats
 ytilicaf gnisrun fo erutidnepxe retaerg hcum a sekat sihT .ycneuqniled ecnalab tiderc  .secnalab tiderc troper dna yfitnedi ylemit ot gniliaf rof
 sredivorp margorp no ytlanep a esopmi dluow taht noitalsigel kees dluohs A FCH ehT
 secnalaB derC
 tropeR ylnuT toN oD hihw ivorP neP oT nitaleL keeS luohS AFCH  hT
 .emit elbanosaer a nihtiw detroper ton secnalab tiderc fo
 erahs laredef eht no tseretni gnissessa redisnoc osla thgim A FCH ehT .ytlibisnopser
 redivorp siht ot sisahpme ytiroirp a hsilbatse taht sweiver ro/dna stisiv etis-no
 ro ,snoisses gnniart ,srettelswen edulcni dluoc ssenerawa redivorp egaruocne ot stroffE
 .emit elbanosaer a nihtiw detroper eb dluohs secnalab tiderc
 taht sredivorp ot ezisahpme ot seicnega diacideM etatS htiw krow dluohs AFCH ehT
 secnalaB derC tropeR dna edI ylnuT ot ivorP magorP
 negA
 fo snerawA eht esaecnI ot  diadeM etatS hiW kroW luohS A FCH  hT
 .stsixe ecnalab tiderc a taht ytlicaf gnisrun
 eht yb noitacifiton retfa syad 06 nihtiw secnalab tiderc diacideM gnidnatstuo yna
 tsujda ot setatS gniriuqer )2159 noitceS( noisivorp tcA noitalicnoceR tegduB subinmO
 detadilosnoC eht ot erehda ot seicnega diacideM etatS eriuqer dluohs A FCH ehT
 secnalaB derC
 fo tnmtsujdA ssecorP yl'1 oT negA diadeM etatS eqeR luohS AFCH  hT
 .rA  xidneppA eeSf )erahs laredef noilim 81$( nollim 23$ sa
 hcum sa eb dluoc secnalab tiderc eudrevo margorp diacideM detcejorp eht ,yllanoitaN
 .sisab gniogno na no secnalab tiderc tsujda ot dna noitcepsni siht yb defitnedi stnuoma
 ecnalab tiderc lautca tsujda ot seicnega diacideM etatS tcurtsni dluohs A FCH ehT
 secnalaB
 negA
 tiderC tsujdA ot nitcA ekaT ot  diadeM etatS egaruocnE luohS A FCH  hT
S
 NOITADNEMMOCER  .meht tcelloc ot noitca decnahne stnarraw dna suoires si secnalab tiderc
 fo melborp eht taht tbuod on si ereht ,lavretni ecnedfnoc ediw a sah etamitse ruo taht
 eerga ew ehW .etamitse sgnivas ruo fo ycarucca eht denoitseuq A FCH eht ,yllaniF
 .pihsrentrap diacideM etatS-laredef
 eht ot evitisnes gniamer elihw noitadnemmocer ruo fo tnetni eht fluf dna sredivorp
 tsniaga seitlanep ssessa ot seicnega etatS eriuqer ot lasoporp evitalsigel a poleved
 dluoc A FCH taht eveileb ew ,siht gnisserdda nI .esoprup siht evres dluow sredivorp
 margorp no decalp ytlanep a taht eveileb ew dna ,secnalab tiderc troper ot dedeen si
 evitnecni tnetop a etartsnomed sgnidif ruo ecnis troper laif ruo ni noitadnemmocer
 siht niater ot detcele evah eW .sredivorp laudividni htiw naht rehtar setatS
 htiw ylirairp slaed elor rieht esuaceb ,rennam ylemit a ni secnalab tiderc troper ton
 od hcihw sredivorp eilanep ot noitadnemmocer ruo htiw deergasid osla A FCH ehT
 .aera siht ni stroffe etatS esaercni ot ygetarts
 llarevo na fo trap sa niaga ti redisnoc lliw A FCH epoh dna tirem sah hcaorppa
 siht eveileb ew ,sselehtreveN .seicnega etatS diacideM tsniaga tseretni gnissessa ni
 etutats yb detil si ti esuaceb noitseggus siht htiw deergasid A FCH .eit elbanosaer
 a nihtiw detroper ton secnalab tiderc fo erahs laredef eht no seicnega etatS tsniaga
 tseretni gnissessa redisnoc ot noitseggus cficeps ruo htiw deergasid AFCH ,revewoH
 .siht eveihca ot gnikat si ti snoitca defitnedi dna ,rennam ylemit a ni secnalab
 tiderc troper dna yfitnedi ot sredivorp margorp fo ssenerawa eht esaercni ot seicnega
 diacideM etatS htiw krow ot noitadnemmocer llarevo ruo htiw deerga osla AFCH ehT
 .ARBOC fo 2159 noitces
 ni deniltuo stnemeriuqer eht ot erehda ot dna ,sisab gniunitnoc a no secnalab tiderc
 tsujda dna fitnedi ot seicnega diacideM etatS tcerid ot secffo lanoiger A FCH
 lla ot mudnaromem a deussi sah A FCH ehT .rennam ylemit a ni stnemtsujda ssecorp
 ot seicnega etatS eriuqer ot dna secnalab tiderc tsujda ot noitca ekat ot seicnega
 diacideM etatS egaruocne ot snoitadnemmocer ruo htiw derrucnoc A FCH ehT
S
 TNEMMOC YCNEGA y
 tilicaf gnisruN*
 561  179 ,42$  327  526 ,25$  )reppu(
996 ,864  01$  963 ,308 ,01$ )rewol(

lavretni ecnedifnoC %09
 239 ,917  71$  645 ,417 ,13$  latoT etamitsE lanoitaN
 erahs laredeF  diacideM
 .573 ,922  erahs laredef etats 5
 .429  392  .624 ,1$
 .992  895  .200 ,1$
 .901  785  .662 ,2$
 .054  427  .036 ,3$
 .195 ,520 ,1$  .419
 dnuoF sralloD  FN reP  .laB .rC  elpmas  .TS
 detce jorp latoT  egarevA  ht iw sFN  ni sFN*
 AHS LAREDEF DIACIDEM
 .369  347  noitcejorP etats 5
 .528  594  .6042$
 .913  250 ,1$  .2671$
 .370  299  .0383$
 .065  251  .6366$
 .381  150 ,2$  .9281$
 dnuoF sralloD  FN reP  .laB .rC  elpmas  .TS
 detce jorP latoT  egarevA  htiw sFN  ni sFN*
 ECLAB TIRC  LANOITAN NA ETATS  DETITSE
A
  XIDNEPPA  391  890 ,81$  )reppu(
 111  868 1 $ )rewol( lavretni ecnedifnoC %09
 .despale dah raey eno retfa
 litnu detroper ton erew hcihw secnalab tiderc 802 eht rof
)erahs  .def 563 ,175 ,5$( 251 ,389,9$ :etamitsE lanoitaN diacideM
 642  101 ,15$  802  latoT
 697  189 ,3 $
 614  794 ,2 $
 402  435  61$
 422  568 ,22$  201
 373  422 ,5 $
 .laB tiderC  .laB tiderC  doirep .ry 1 retfa  etats
rep .tmA .qvA  fo .tmA $  detropeR toN s 'laB
 tiderC fo #
 795  026 ,08$  531  latoT
 665  844 ,21$
 068  340 ,21$
 134  846 ,11$
 994  254  43$
 343  920 ,01$
 .laB tiderC  s .laB t iderC  syad  54  niht iw  etats
rep .tmA .qvA  fo .tmA $  detropeR toN s 'laB
t
 iderC fo #
 ETROPER  YNU ECLAB  TIDRC
 XIDNEPPA 1
  - C
 600  86$  611  167  44$  802  614  LATOT
 026 9 $  985 ,11$
 623 9 $  920 6 $
 398 ,9 $  678 ,11$  621
 329  72$  762 ,51$  781
 442  11$
 06  06  06  06  deussi  secnalaB  .TS
.jdA fo  .tsujdA  .jdA fo  .tsujdA  secitoN  t iderC
 .tmA $  .tmA $  fo #  fo #  fo #
 EICNEGA ETATS YB TNMTSmDA  YLNU
C
  XIDNEPPA I - a

ffJ HL'I 
NOlL  DNIJNVNId 
SlawOJ  SINav
G XIGN3ddV
  21115/060-225-  2S!' ;ECIFFC ;:S:TNII'P TNEM'"RFvnc su -
 tnemhcattA
 .ecneinevnoc tseilrae
 ruoy ta snoitadnemmocer s troper eht no noitisop ruo htiw eerga uoy rehtehw su
 esivda esaelP .troper tfard siht no tnemmoc ot ytinutroppo eht rof uoy knahT
 .dehcatta era stnemmoc deliated ruO .yllanoitan
 dna etatS eht ni sFN lla ot sFN delpmas morf sgnidnif eht ezilareneg ot desu
 snoitcejorp lairautca eht dna ygolodohtem eht htob eoncsed GIO taht gnitseuqer
 era ew ,eroferehT .setatS rehto ssorca emas eht era snoitidnoc lla semussa troper
 eht sa )devres slaudividni fo rebmun ,  .e( setatS eht ssorca secnereffid FN erutpac
 tOn seod osla tI .secnalab tiderc FN lanoitan tcelter yletarucca ton seod sFN
 fo elpmas ytlicaf 94 ,etatS 5 a eveileb eW .secnalab tiderc FN latot fo etamitse
 elbailer a decudorp ton sah GIO yb desu ygolodohtem gnilpmas eht taht denrecnoc
 era ew ,revewoH .snoitadnemmocer s'GIO fo ytirojam eht htiw eerga eW
 .stnuocca ecnalab tiderc FN ni gnidnatstuo eb dluoc
 )erahs laredeF noilim 81$( nollim 23$ sa hcum sa taht stcejorp GIO ,weiver eht no
 desaB .)FN( s  it1icaf gnisrun ta stnuocca tneitap ni secnalab tiderc fo weiver s 'GIO
 stluser eht sezirammus hcihw troper decnerefer-evoba eht deweiver evah eW
 yraterceS eht fo ecffO
 lareneG rotcepsnI
 )11900-09-70-IEO(
 stnuoccA tneitaP ytilicaF gnisruN ni secnalaB tiderC diacideM" :iropeR tfarD GIO
t	cejbuS
 artsinimdA gnitcA
nosduH leahciM .J  morF
91 I  RPA e	 taD
 mudnaromeM
n
 oitartsinimdA gnicnaniF  SECIVRES NAMUH .& HTLAEH FO TNEMTRAPED
 era.I ntlaeH  .stsixe ecnalab tiderc a taht FN eht yb
 noitacifiton retfa syad 06 nihtiw secnalab tiderc diacideM gnidnatstuo yna tsujda ot
 setatS seriuqer noitces sihT .tcA noitalicnoceR tegduB subinmO detadilosnoC eht
 fo 2159 noitces ni deniltuo stnemeriuqer eht ot erehda ot seicnegA etatS diacideM
 tcerid ot 81 yraurbeF no sOR eht ot mudnaromem a deussi eW .rucnoc eW
 esnopseR AFCH
 .secnalab tiderc
 fo tnemtsujda ssecorp ylemit ot seicnega diacideM etatS eriuqer dluohs A FCH
 noitadnemmoceR GIO
 .noitca evitcerroc yrassecen eht gnitnemelpmi ni su tsissa dluow
 ti ,troper lanif eht ni dedivorp erew noitamrofni siht fI .ecnetsixe rieht fo seicnega
 diacideM etatS eht yfiton
 ro secnalab tiderc eht timer ton did deyevrus sredivorp
 eht yhw snosaer eht edivorp GIO taht gnitseuqer era eW .etatS ralucitrap yna ni
 melborp ecnalab tiderc eht fo tnetxe eht enimreted sredivorp laudividni fo secitcarp
 gnitnuocca eht dna setatS eht fo seicilop tnemesrubmieR .etatS eht yb noitapicitrap
 laicnanif laredeF fo nruter eht gniriuqer tnemyaprevo na si ereht etacidni ylirassecen
 ton seod ecnalab tiderc a fo ecneserp erem eht ,revewoH .secnalab tiderc
 deifitnedi ylreporp rehto dna secnalab tiderc eseht tsujda ot nekat eb dluohs noitca
 stnuocca esnepsus ro miretni ni dleh era secnalab tiderc deniatniam-redivorp erehW
 .sisab gniunitnoc a no stnuocca ecnalab tiderc )FN( ytilicaf gnisrun tsujda dna
 yfitnedi ot seicnega etatS diacideM detcerid ew ,81 yraurbeF detad )sOR( seciffo
 lanoiger AFCH lla ot mudnaromem a nI .noitadnemmocer siht htiw rucnoc eW
 esnouseR AFCH
 .secnalab
 tiderc tsujda ot noitca ekat ot seicnega diacideM etatS egaruocne dluohs A FCH
 noitadnemmoceR GIO
 900-09- 70- XE O(
 stnuoccA tneitaP vtilicaF !(nisruN ni
 secnalaB tiderC diacideM" :tropeR tfarD s'GIO no
 noitartsinimdA !(nicnaniF eraC htlaeH eht fo stnemmoC  .secnalab tiderc
troper ylemit ton od hcihw sredivorp ezi1anep ot noitalsigel kees dluohs AFCH
 noitadnemmoceR GIO
 .secnalab tiderc no tseretni fo noitisopmi eht timrep ot egnahc
 evitalsigel a eriuqer ot hguone tnacfingis ton si devlovni srallod fo tnuoma 1Iams eht
 ,noitidda nI .stnuocca gniraeb-tseretni fo ecnetsixe eht ytitnedi ton seod troper ehT
 .secnalab tiderc eht fo erahs laredeF eht ot noitidda ni denrae tseretni fo erahs
 laredeF eht nruter tsum ycnegA etatS eht neht ,secnalab tiderc fo erahs laredeF
 eht no tseretni nrae ot erew sFN eht fI .)83.334 RFC 24 dna tcA ytiruceS laicoS
 eht fo )5()d(3091 noitces( draoB slaeppA latnemtrapeD eht erofeb laeppa sti sesol
 etatS eht dna ecnawollasid lamrof a fo tluser a sa etupsid ni sdnuf niater ot stcele
 ycnega etatS a fi ylno tseretni ssessa eW .seicnega etatS diacideM tsniaga tseretni
 gnissessa ni etutats yb detimil si A FCH ,ereh elbacilppa ton snoitpecxe niatrec
 rof tpecX'E .emit elbanosaer a nihtiw detroper ton secnalab tiderc fo erahs laredeF
 eht no tseretni gnissessa redisnoc AFCH taht tnemmoc s'GIO htiw eergasid eW
.
 noisnapxe hcus tnarraw secruoser
 dna secnatsmucric fi slatipsoh sa lIew sa sFN edulcni ot secnalab tiderc deniatniam
-redivorp fo sweiver ruo gnidnapxe redisnoc Iiw ew ,sweiver tnemeganam
 laicnanit 3991 )YF( raey lacsif eht gninnalp ni ,revewoH .slatipsoh no sisahpme eht
 decalp evah ew ,tsap eht nI .secnalab tiderc diacideM nwonk gnirevocer ni setatS
 eht fo stroffe noitcelloc eht rotinom ew ,margorp diacideM rednU tnemesrubmieR
 fo tseT evisneherpmoC dna noitaulavE ecnamrofreP etatS eht fo trap sA
 .sweiver eseht gnitcudnoc rof sOR eht ot serudecorp sedivorp
 dna eussi siht gnitceffa ycilop tnemesrubmier-tsoc dna ,tnemyaprevo ,ytlibail
 ytrap driht serolpxe -ediug sihT .diacideM ni secnalab tiderc deniatniam-redivorp
 rof ediuG weiveR tnemeganaM laicnaniF a deussi ew ,8891 ,92 rebmetpeS nO
 esnoDseR A FCH
 .secnalab tiderc troper dna yfitnedi ylemit ot sredivorp margorp
 fo ssenerawa eht egaruocne ot seicnega diacideM etatS htiw krow dluohs A FCH
 noitadnemmoceR GIO
2
  egaP  tnemhcattA
 .stnemyap .
 hcus ot stnemtsujda dna setatS ot stnemyap rof )d (3091 dna sFN ot tnemyap
 diacideM rof tcA ytiruceS laicoS eht fo )A()31()a(3091 snoitces era setic diacideM
 tcerroc ehT .etutats eracideM eht secnerefer troper diacideM sihT .stnemyaprevo
 rof tnuocca ot stnemyap etatS tsujda ot yraterceS eht eriuqer dna tnemyap
 FN rof edivorp taht stnemeriuqer yrotutats diacideM eht etic ton seod troper ehT
 tnemmoC lacinhceT
 .rotcaf lanoitidda siht
 fo noissucsid a edulcni troper eht dnemmocer eW .stnemyaprevo fo erahs laredeF
 eht rof tsujda ot. sdrawa tnarg etatS decuder sah yraterceS eht hcihw ot tnetxe eht
 sserdda ton seod troper eht ,oslA .snoitcejorp ecnalab tiderc lanoitan dna ediwetats
 detamitse eht tesffo ot desu eb etamitse siht dnemmocer ew ,rehtruF .secnalab
 tiderc rof stnemyap ytlicaf ot stnemtsujda lanoitan dna ediwetats fo setamitse
 edulcni troper eht taht dnemmocer eW .edam erew taht stnemtsujda etatS
 yb tesffo ton erew troper eht ni stnemyaprevo fo setamitse eht ,revewoH .secnalab
 tiderc ot eud stnemtsujda emos edam evah setatS taht setacidni C xidneppA
 .elbanoitseuq eb yam dehcaer noisulcnoc eht dna ,detamitserevo eb yam troper
 eht ni nwohs snoitcejorp dna snosirapmoc eht taht sraeppa ti ,tluser a sA .ytlicaf
 rep mialc keew-tneitap eno yletamixorppa tneserper ecnalab tiderc rep tnuoma
egareva eht rof serugif GIO ,snoitaluclac ruo ot gnidroccA .ylemitnu denoper
 stnuoma ecnalab tiderc eht dna 0991 YF rof sFN ot edam stnemyap ecnatsissa
 lacidem latot neewteb pihsnoitaler eht setartsuli trahc A FCH dehcatta ehT
 .detatsrevo eb yam secnalab tiderc gnitsixe fo )noilim 6.02$( noitcejorp lanoitan
 'GIO eveileb ew ,eulav rallod ni llams ylevitaler si hcae rof tnuoma lanigiro eht
 dna derevocsid secnalab tiderc fo rebmun lautca eht ecnis dna ,snoitcejorp lacitsitats
 'GIO yfirev ot elbanu era ew ecniS .snoitcejorp lairautca eht fo ytidilav eht
 ot drager htiw snoitvreser emos evah ew tub ,delpmas saw hcihw noitalupop eht ni
 seicneicifed eht sserdda ot deen a etacidni troper siht ni sgnidnif eht taht eerga eW
 stnemmoC lareneG
 .margorp
 tnempoleved evitalsigel ruo fo noitalumrof eht gnirud noitadnemmocer siht redisnoc
 ot etairporppani eb dluow ti eveileb ew ,yltneuqesnoC .sredivorp laudividni
 htiw ton ,etatS eht htiw si pihsnoitaler s'AFCR .setatS eht yb deretsinimda tub
 stnemnrevoG etatS dna laredeF eht yb decnanif yltnioj  si  margorp diacideM ehT
e
 snopseR A FCR

3 egaP  
. 0
. 9
. 9
...... ........ l Share) . fY 1 Percentage Total *  O. OOOX  000"  o. OOOX  OOOX  OOOX 
. a
. r
. e
... ed e 
............................... ..... ................. ............. ..... --, ---,",-....................................................... .... .......... .................."-'---:. -- ,,_ on of Credit Pavmnts (fBalances Untlme'v Reported with Total Hedlea' Assistance  Patient Accouts OIG Draft Report: Hedlcald Credit Balances In Nursing facl'ltv  Dollar Amt. Credit Dollar Amt. Credit "edlcal Assistancpaymnts for Bal. Bal. s not reported s not reported NFs in millions period within 45 days after 1 yr.  029 1610. $10 224  $22 452 665 $354. . $34  $11, $16 648 534 $111.  S2, 491 $12, 043 $555.  $12, $301. 448 961  figures, separately and taken together.
*Applles to 45-day and yr Note that the credit balances reported by the OIG are less than 1/1000X
paymnts for each Stateof the total medical assistance , and approximate zero.

... ris e 
..-... ma tat
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