Department of Health and Human Services

Office of Inspector General -- AUDIT

"Medicaid Payments for Services Provided to Beneficiaries With Concurrent Eligibility in the District of Columbia and Maryland for July 1, 2005 Through June 30, 2006 - The District of Columbia Department of Health," (A-03-07-00214)

April 30, 2008


PDF File Complete Text of Report is available in PDF format (368 kb). Copies can also be obtained by contacting the Office of Public Affairs at 202-619-1343.


EXECUTIVE SUMMARY:

For the period from July 1, 2005, through June 30, 2006, we estimated that the State agency paid: $1,902,080 (Federal share $1,331,456) for Medicaid services provided to beneficiaries who should not have been eligible due to their Medicaid eligibility/residence in Maryland and $3,944,006 (Federal share $2,760,805) for Medicaid services provided to beneficiaries whose residence could not be determined from the information in the State agency’s and Maryland Medicaid agency’s case files.  Both the District of Columbia and Maryland require that Medicaid beneficiaries be residents. 

We recommended that the State agency work with the Maryland Medicaid agency to share available Medicaid eligibility information for use in: determining accurate beneficiary eligibility status, and reducing the amount of payments, estimated to be $1,902,080 ($1,331,456 Federal share), made on behalf of beneficiaries residing in Maryland.  We also recommended that the State agency: determine the place of residence associated with beneficiaries who received services totaling $3,944,006 (Federal share $2,760,805), but whose residency could not be established, and verify addresses of all beneficiaries including those on Supplemental Security Income and children.   In a letter the State agency advised us of actions it was taking to implement our recommendations.