Family and Children's Medicaid MA-3535 RECIPIENT FRAUD AND ABUSE POLICY AND PROCEDURES
XV. EPICS Reporting Requirements
DMA Quality Assurance is responsible for the administration of the Medicaid recipient investigations conducted by the county departments of social services. In order to comply with state and federal reporting requirements, each county is responsible for entering all fraud and client responsible overpayment claims into EPICS. (Refer to the EPICS User’s Guide for system instructions.)
A. County Incentive Payments
In an effort to offset county administrative costs for program integrity activities and staff and provide cost savings through increased investigation and collection of Medicaid overpayments, the Division of Medical Assistance implemented a county incentives program for collections of client responsible overpayments effective February 1, 1997.
1. The county departments of social services receive monthly incentive payments from the Division of Medical Assistance based on collections for recipient responsible overpayments.
2. The calculation for county incentive payments is based on one-half of the non-federal share of county collections for client responsible medical assistance overpayments.
3. The county, state, and federal reimbursement rates vary slightly from year to year. The county incentive is based on the actual state and county reimbursement rates that were in effect during the overpayment period captured in EPICS.
4. Incentive payments are based on collections keyed into EPICS. Collections are passed from EPICS to the Medicaid Accounting System and incentive
payments are credited back to the county through the monthly Medicaid Adjustment Register.
B. State law requires the following actions regarding reporting the status of fraud/overpayment cases:
1. The county dss must provide a detailed report on each case that is initiated or investigated. This report must be provided within 6 months from the date the Medicaid Recipient Profile is requested. EPICS is designated for this function.
REISSUED 7/01/08 - CHANGE NO. 11-08
2. Data on EPICS claims are accessible in reports generated in NCXPTR, as claims are entered and funds collected in EPICS. Refer to the EPICS User’s Guide for a list of reports accessible to the county dss.