Michigan Nursing Home Administrator (NHA) Practice Exam

What is the consequence of receiving payments from other sources after Medicaid has paid for services?

1. Facility keeps the payments as profit

2. Facility must report and refund the excess to MSA

3. Facility must donate the excess to charity

4. Facility can use the payments for facility improvements

The correct answer is: Facility must report and refund the excess to MSA

When a facility receives payments from other sources after Medicaid has compensated it for services, the correct course of action is to report and refund the excess payments to the Michigan Department of Health and Human Services, specifically the Medical Services Administration (MSA). This requirement is in place to ensure that Medicaid does not pay for services that are already covered by another payer, preventing double billing and ensuring that funds are allocated appropriately. Medicaid is designed to provide a safety net for individuals who have limited resources, and any additional payments received can violate federal and state regulations regarding reimbursement policies. This means that if a facility were to keep the additional funds as profit, it would not only be unethical but also potentially illegal, as it could lead to overpayment issues and affect future Medicaid funding and compliance. By reporting and refunding the excess payments, the facility maintains compliance with Medicaid regulations, ensuring that they are upholding their responsibilities as a provider within the Medicaid system. This also helps preserve the integrity of the Medicaid program and its funding for those in need.