Kansas was overpaid by nearly $18 million by the Centers for Medicare and Medicaid, according to a new report that recommends the state reimburse the federal government.

Overpaid funds came as bonus payments aimed at offsetting the cost of an increased number of children in Medicaid.

The report released earlier this month by the Office of the Inspector General at the U.S. Department for Health and Human Services says the state overstated its child Medicaid population for five consecutive fiscal years by including children who were not eligible. Kansas got the bonus payments based on that inflated population. The state disagrees. It says it followed CMS guidelines on bonus payments.

“As a result of the overstated current enrollment numbers, CMS overpaid Kansas $17.8 million in bonus payments,” the report brief says. “We recommend that Kansas refund $17.8 million to the federal government.”

Angela de Rocha, a spokeswoman for the Kansas Department of Health and Environment, which helps oversee the state’s Medicaid program, said in an email the agency did not agree with the report.

“KDHE does not believe more money was requested than was allowed,” de Rocha said.

Christiane Swartz, Kansas’ deputy Medicaid director, outlined the state’s issues with the report in a letter responding to the federal government. Swartz said Kansas followed CMS direction on which children were eligible to be counted for bonus payments.

“Kansas understands the importance of utilizing federal Medicaid funds appropriately,” Swartz said. “This was no exception.”

Despite the state’s issues with the report, the federal government stuck to its recommendation.

“After review and consideration of Kansas’ comments, we maintain that our findings and recommendation are correct,” the report brief says. “CMS has consistently and reasonably interpreted the statute and explained to Kansas that only individuals from [basis-of-eligibility] categories 4, 6, and 8 should be included in Kansas’ current enrollment.

De Rocha said the audit report was a mere recommendation, not an order for Kansas to repay the funds and that CMS has not asked for the funds. CMS did not immediately return a request for comment.

Kansas is one of several states targeted by similar reviews. Ohio also came under scrutiny for what the inspector general claims was $29.5 million in wrongful bonus payments. The state also challenged the finding, but the inspector general’s office maintained its position.

Since 2013, Alabama, Washington, Louisiana, Wisconsin, North Carolina, New Mexico and Colorado have also been subjects of similar probes. Most of those states challenged the report’s findings and said they calculated their request based on CMS guidance.