Medicaid Overpayments Made to Hawaii Should Be Disallowed

Gao ID: HRD-85-47 March 20, 1985

GAO reviewed Hawaii Medicaid operations to determine if federal Medicaid funds were properly used as a secondary resource to pay for medical costs that resulted from motor vehicle accidents.

GAO found that: (1) Hawaii did not always follow federal statutory requirements to use other insurance available to Medicaid recipients before Medicaid; (2) under its no-fault motor vehicle insurance law, Hawaii allowed insurers to exclude medical coverage for Medicaid recipients, who in certain circumstances, were injured while driving their vehicles; and (3) when the coverage for Medicaid recipients was not excluded, Hawaii was not actively pursuing collections from the no-fault insurers. GAO estimated that, during fiscal years 1982 to 1984, 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.

Recommendations

Our recommendations from this work are listed below with a Contact for more information. Status will change from "In process" to "Open," "Closed - implemented," or "Closed - not implemented" based on our follow up work.

Director: Michael Zimmerman Team: General Accounting Office: Human Resources Division Phone: (202) 275-6195


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