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OHA director details another $112 million in possible Medicaid errors

The figure is on top of the state's estimated overpayment of $74 million to coordinated care organizations.

FILE PHOTO - In a letter Friday to Gov. Kate Brown, the director of the Oregon Health Authority reported the agency may have erroneously paid, allocated, inaccurately recorded or over-claimed $112.4 million in health care funds. That's in addition to $74 million overpaid to coordinated care organizations.SALEM — Oregon may have erroneously paid, allocated, inaccurately recorded or over-claimed $112.4 million in health care funds, according to a letter Oregon Health Authority Director Pat Allen sent to Oregon Gov. Kate Brown Friday.

That figure is on top of the state's estimated overpayment of $74 million to coordinated care organizations, or CCOs, the state's regional networks of Medicaid providers, between 2014 and 2016.

Allen's letter follows his statement to legislators this week that the state was likely to see more processing problems come out of the state's health agency.

"...We note that this is likely not an exhaustive and final list of all known issues facing the agency," Allen wrote Friday. "It is also likely that the details of these issues will evolve as we research them and consult in more detail with subject matter experts."

Allen documented two main types of issues: those relating to $44.5 million in possible payment errors; and issues relating to the allocation of about $67.9 million of funds, which range from charging the wrong section of the state's budget to claiming federal funds for certain procedures that cannot be paid for with federal money.

Allen was careful to note that all of those numbers are estimates, and subject to change based on deeper research into the problems.

Two weeks ago, it came out that the state had overpaid CCOs by approximately $74 million for certain patients who were eligible for both Medicaid and Medicare due to classification errors.

But the state says $74 million is still an estimate. Medicare, a program funded solely by the federal government, may share some of the tab.

The state has already recouped $10.1 million of that $74 million figure from CCOs.

In Oregon, about 1.1 million people are on Medicaid, which is funded jointly by the state and the federal government and covers the poor and other qualifying groups. Medicare is the health care coverage program for those 65 and older.

Allen said in the Friday letter that the agency will create an issue log to document ongoing problems and provide bi-weekly reports to the governor and state lawmakers.

The news also comes prior to the completion of an OHA audit by the secretary of state, expected to be released by early December.

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