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Audit (A-05-12-00087)

05-22-2014
Ohio Did Not Always Properly Claim Medicaid Reimbursement for Hospice Claims

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Summary

The Ohio Department of Job and Family Services State agency did not always properly claim Federal Medicaid reimbursement for hospice claims. Of the 100 sampled claims, the State agency properly claimed Federal Medicaid reimbursement for 84 claims. The State agency did not properly claim Federal Medicaid reimbursement for the 16 remaining claims. However, the unallowable dollar amounts related to these 16 claims are immaterial. For the 16 improper claims, the hospices did not claim the correct room and board rate (9 claims) and did not properly apply the patient liability portion to the claimed room and board amount (7 claims).

In addition, hospices did not always meet election statement requirements. Of the 100 claims reviewed, hospices met the election statement requirements for 40 claims. Hospices did not meet the election statement requirements for the remaining 60 claims. For these claims, the hospices did not maintain a Medicaid election form on file (46 claims) and did not ensure election statements contained required language (14 claims). A dually eligible beneficiary must elect both Medicare and Medicaid hospice benefits. However, for Medicaid payment, claims for room and board are not considered hospice benefits. Therefore, we did not take exception to the 60 claims or estimate an error rate or improper payment amount.

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