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Florida Medicaid: Millions in Overpayments Not Refunded

The Florida Agency for Health Care Administration (State agency) did not return the Federal share of Medicaid overpayments identified or collected by the Florida Department of Children and Families (the Department). From July 1, 2007, through June 30, 2010, the Department identified $22.3 million ($12.2 million Federal share) in Medicaid overpayments. Of this amount, the Department collected $2.5 million ($1.4 million Federal share) but had not collected the remaining $19.8 million ($10.8 million Federal share). The State agency did not return the Federal share of either the collected or uncollected amounts to CMS. In addition, the Department collected $1.5 million ($852,000 Federal share) of overpayments after our audit period, from July 1, 2010, through June 30, 2012.

The State agency did not return the Federal share of Medicaid overpayments because it did not adequately coordinate with the Department to ensure that the Department reported collections of Medicaid overpayments in accordance with Federal and State requirements.

We recommended that the State agency (1) repay the $1.4 million Federal share of Florida State Medicaid overpayment collections during our audit period (July 1, 2007, through June 30, 2010), (2) repay the $852,000 Federal share of Florida State Medicaid overpayment collections during the 2 State fiscal years (July 1, 2010, through June 30, 2012) after our audit period, (3) improve coordination with the Department to report State-identified Medicaid overpayments and collections, and (4) work with CMS to determine whether the State must repay the $10.8 million Federal share of the recipient overpayments identified but not collected. The State agency generally concurred with our recommendations.

Filed under: Center for Medicare and Medicaid Services