EXECUTIVE SUMMARY:
This final report provides the results of our review of State agency controls over Medicaid payments for clinical laboratory services. The review disclosed that, although the State agency had numerous edits for detecting duplicate and other inappropriate billings, additional edits were needed in the Medicaid claims processing system. The review identified ovepayments related to laboratory tests that were inappropriately billed separately when they should have been billed only as part of a group of tests (bundled services). We estimated that, if the State agency were to implement additional edits to detect problems with bundling or duplication, about $1.8 million in Federal and State funds could be saved for the Medicaid program over a period of 5 years.