Problems in Carrying Out Medicaid Recovery Programs from Third Parties

HRD-77-73: Published: May 2, 1977. Publicly Released: May 2, 1977.

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There are problems involved in implementing the third-party recovery programs which are required to be part of the states' Medicaid programs.

Third parties, such as health or automobile accident insurance companies, may be liable to pay part or all of the medical costs of injury, disease, or disability of a Medicaid applicant or recipient. States are responsible for identifying and recovering funds from these third parties. The Department of Health, Education, and Welfare's (HEW) Audit Agency and consultants have repeatedly reported inadequacies in state recovery. The six states whose programs were reviewed used various procedures and approaches to identify liable third parties, to recover or avoid cost applicable to them, and to account for and report recoveries or cost avoidances. Claims are sometimes paid without a thorough investigation of third-party liability.

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