Improvements to Ohio Medicaid Hospital Payment Recalculations

Over several years of back and forth between the OIG (Office of the Inspector General) and ODM (Ohio Department of Medicaid), it was determined that data provided by eligible hospitals to calculate aggregate incentive payments during the attestation and review phase of the program were inaccurate, and that this was largely due to a timing issue.

In order to comply with the OIG audit findings, and to prevent the OIG from enforcing their original findings, ODM agreed to go back and review all aggregate hospital payments issued via the MPIP (Medicaid Provider Incentive Program) program.

The team performed root cause analysis on the audited financial data and identified reasons why there were over and under payments. They were able to eliminate loopbacks and decisions.

https://lean.ohio.gov/Portals/0/docs/A3/MCD_Emma_Esmont_A3.pdf

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