Iowa Medicaid Providers Subject to Increased Scrutiny for Medicaid Overpayments

On January 23, 2018, the Iowa Department of Human Services (DHS) announced that it will begin using statistical sampling to determine whether Iowa Medicaid providers have received overpayments from Iowa Medicaid Enterprise (IME), including from the Managed Care Organizations (MCOs), and the Iowa Dental Wellness Plan.

Pursuant to Informational Letter No. 1879-NC-FFS-D, IME will begin extrapolating the results of program integrity reviews as of February 23, 2018.  This will allow IME to calculate the amount of an overpayment based on the entire claim universe of the provider, instead of just the claims being reviewed.

This new extrapolation process is further explained in the Informational Letter, the programs Frequently Asked Questions, and a response from Iowa DHS dated February 2, 2018 providing additional clarification.