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Family and Children's Medicaid MA-3535 RECIPIENT FRAUD AND ABUSE POLICY AND PROCEDURES

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VIII. CALCULATING OVERPAYMENTS

REVISED 11/01/11 - CHANGE NO. 15-11

(VIII.A.4.)

REVISED 03/01/11 - CHANGE NO. 05-11

(VIII.A.9.)

REISSUED 03/01/11 - CHANGE NO. 05-11

(VIII.A.12.b.)

REVISED 03/01/11 - CHANGE NO. 05-11

(VIII.B.2.c.(3))

REVISED 03/01/11 - CHANGE NO. 05-11

(VIII.B.3.c.)

On 7/17/09, a 38 year old applicant applied for Medicaid for herself and eight year old son. She reported being on medical leave from Little Debbie’s since 6/10/09 due to an injury she sustained at home. She provided a letter from her employer verifying she was on medical leave and her last pay received 6/30/09. No other pay was expected. She also indicated being interested in Family Planning services. She was approved on 7/23/09 for MAF-C from 7/01/09-12/31/09 and her son for MIC from 7/01/09-6/30/10.
If the recipient had reported her employment timely, she would have had a deductible effective 09/01/09. Since the countable income exceeds the CN income limit of $472, eligibility must be evaluated for the MN with a deductible.

REVISED 03/01/11 - CHANGE NO. 05-11

(VIII.B.3.c.)

REISSUED 7/01/08 - CHANGE NO. 11-08

(VIII.B.4.)

REVISED 11/01/11 - CHANGE NO. 15-11

(VIII.C.2.b.)

REISSUED 11/01/11 - CHANGE NO. 15-11

(VIII.C.4.d.)

REISSUED 7/01/08 - CHANGE NO. 11-08

(VIII.C.4.e.)

REISSUED 7/01/08 - CHANGE NO. 11-08

(VIII.E.3.b.)

REVISED 03/01/11 - CHANGE NO. 05-11

(VIII.F.3.)

Request a Medicaid/NCHC Recipient Profile for the dates of service in question. Compare the providers who billed Medicaid to the transportation reimbursement logs.

REVISED 03/01/11 - CHANGE NO. 05-11

(VIII.G.6.)

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