22.2 Overpayments

An overpayment occurs when any of the following occur:

Medicaid benefits are incorrectly paid for a person who was not eligible for them.
A MAPPMedicaid Purchase Plan member should have paid a higher premium.
A long-term care member did not pay as much as they should have for their nursing home patient liability or waiver cost share.

Effective April 1, 2023, DHS and IM agencies will not establish new Medicaid overpayment claims for members.

Income maintenance (IM) agencies may refer suspected fraudulent activity to the DHS Office of Inspector General (OIG), the district attorney (DA), or corporation counsel for investigation. The DA or corporation counsel may prosecute for fraud.

Note	This policy on member overpayment claims does not include provider overpayments where there is an error in a claims payment to a provider or repayments that are part of the Estate Recovery Program (see Section 22.1 Estate Recovery).

This page last updated in Release Number: 23-02
Release Date: 04/17/2023
Effective Date: 04/17/2023

The information concerning the Medicaid program provided in this handbook release is published in accordance with: Titles XI and XIX of the Social Security Act; Parts 430 through 481 of Title 42 of the Code of Federal Regulations; Chapters 46 and 49 of the Wisconsin Statutes; and Chapters HA 3, DHS 2, 10 and 101 through 109 of the Wisconsin Administrative Code.

Notice: The content within this manual is the sole responsibility of the State of Wisconsin's Department of Health Services (DHS). This site will link to sites outside of DHS where appropriate. DHS is in no way responsible for the content of sites outside of DHS.

Publication Number: P-10030