Medicaid hearing aid services draw auditor’s attention

TRENTON – The state Auditor this morning issued a report regarding various medical services, including a finding that costs for hearing aid services under Medicaid are unreasonable and in some cases questionable.

Hearing-aid providers’ claims are not reviewed for accuracy or billing errors, according to the Auditor’s report.

From July 1, 2008 through June 27, 2011, according to the audit, hearing-aid and related claims totaled $19 million for 12,300 recipients. Such claims have risen from $3.6 million for 6,000 recipients in fiscal year 2007 to $7.1 million for 7,000 recipients in fiscal year 2010.

Noting that providers often receive discounts from the manufacturers, the audit found that a review of 70 hearing aid claims from 26 providers showed only four with a discount.

One provider billed Medicaid $2,295 when the invoice, with a discount, showed $1,056 as the cost, the audit stated.

Another example showed a billing of $2,900 when the invoice was $915.

The report found an overbilling of $53,000 from a provider who admitted submitting 25 duplicate and four unsupported claims.

That provider’s files were kept so poorly that the auditors could not confirm the validity of 56 other claims totaling $82,000.

The audit found other problems, such as an unusual number of recipients receiving more than one hearing aid over a five-year period.

In conclusion, the state said the controls in place are insufficient to monitor this program.

The audit advised that other states have dealt with such issues by instituting prior authorization for costs and limiting the number of hearing aids a recipient can obtain over a period of time.

The Department of Human Services in a written response to the audit said that it will require proof of costs before approving reimbursements.

In addition, it said it will require prior authorization for high-cost devices.

 

Medicaid hearing aid services draw auditor’s attention