PORTLAND, Ore. — The state wrongly paid Oregon health care organizations nearly $75 million in federal Medicaid money from 2014 to 2016, and might have to repay all of it, the Oregon Health Authority said.
New chief financial officer Laura Robison told The Oregonian/OregonLive that the overpayments occurred because the health agency paid health care organizations it contracted with to serve certain senior Medicaid patients inaccurate, excessively high rates.
The revelation comes about three months after Gov. Kate Brown fired Lynne Saxton as director of the health authority. The newspaper reports Saxton and other top officials knew about the overpayments, but withheld the information.
The governor wasn’t told of the problem until Oct. 17, and finds that unacceptable, said her spokesman, Chris Pair.
The incorrect payments occurred in the cases of patients old enough to qualify for Medicare and poor enough or otherwise qualified for Medicaid, Robison said. Medicare pays first and should have been used to cover most costs. Instead, Oregon charged the federal government — and paid Oregon firms contracted to manage those patients’ Medicaid services — as much as if those patients had had no other insurance.
Federal officials caught the problem in 2016 and required Oregon to repay $10 million, according to public records released by the state. Now, it appears Oregon may have to repay the balance, Robison said. It might choose to try and recover some or all of the money from the health care agencies formed to administer Medicaid payments, known as coordinated care organizations.
In another problem, Robison said the agency also paid health care contractors an undetermined amount to provide health care to people who’d been retroactively deemed ineligible for Medicaid. She said the agency is still trying to determine how much money was wrongly dispensed.
“These issues landed on my desk essentially on my arrival at (the Oregon Health Authority), and I’ve made it a priority to get these fully scoped and resolved as soon as possible,” Robison said.