Department of Health and Human Services

Office of Inspector General -- AUDIT

"Medicaid Payments for Services Provided to Beneficiaries With Concurrent Eligibility in Florida and Georgia for July 1, 2005, Through June 30, 2006," (A-04-08-03034)

June 3, 2008


PDF FileComplete Text of Report is available in PDF format (747 kb). Copies can also be obtained by contacting the Office of Public Affairs at 202-619-1343.


EXECUTIVE SUMMARY:

For the period July 1, 2005, through June 30, 2006, we estimate that the Florida Agency for Health Care Administration (the State agency) paid $3.7 million ($2.2 million Federal share) on behalf of beneficiaries who should not have been eligible due to their Medicaid eligibility in Georgia.  Medicaid eligibility in each State is based on residency.  If a resident of one State subsequently establishes residency in another State, the beneficiary’s Medicaid eligibility in the previous State should end.  From a statistical random sample of 100 beneficiary-months totaling $77,000 in Medicaid services, the State agency made payments for 68 beneficiary-months totaling $68,000 for services provided to beneficiaries who should not have been eligible to receive Medicaid benefits in Florida.  Twenty-five beneficiary-months were for services to beneficiaries who were eligible to receive the benefit.  For the remaining seven beneficiary-months totaling $522, we could not determine the beneficiaries’ eligibility based on the documentation that the State provided.

We recommended that the State agency work with the Georgia Medicaid agency to share available Medicaid eligibility information for use in determining accurate beneficiary eligibility status and reducing the amount of payments made on behalf of beneficiaries residing in Georgia.  We also recommended that the State agency work with CMS to determine the residency of beneficiaries whose eligibility could not be determined.  The State agency deferred formal comments to the Florida Department of Children and Families (DCF), which DCF generally disagreed with our findings and recommendations.  However, nothing in the comments prompted changes to our findings or recommendations.