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Georgia Made Unallowable Capitation Payments for Beneficiaries Assigned Multiple Medicaid Identification Numbers

Georgia made capitation payments on behalf of beneficiaries who were assigned multiple Medicaid identification (ID) numbers. Of the 100 beneficiary matches in our sample, Georgia correctly claimed reimbursement for capitation payments on behalf of 28. However, Georgia incorrectly claimed multiple capitation payments that totaled $201,561 ($132,765 Federal share) on behalf of the remaining 72. Of the 72 beneficiary matches that had multiple capitation payments within our audit period, 48 had additional payments that were outside of our audit period and totaled $192,101 ($126,488 Federal share). The improper payments made on behalf of these beneficiaries occurred because Georgia used several systems to input and assign Medicaid ID numbers to beneficiaries but did not properly identify when beneficiaries had multiple Medicaid ID numbers. On the basis of our sample results, we estimated that Georgia made unallowable capitation payments between July 1, 2011, and June 30, 2014, totaling at least $821,295 ($540,984 Federal share) on behalf of beneficiaries with multiple Medicaid ID numbers.

We recommended that Georgia refund $540,984 (Federal share) in overpayments that fell within our audit period and $126,488 (Federal share) in overpayments that fell outside of our audit period. In written comments on the draft report, Georgia agreed with our findings and recommendations and outlined the corrective actions that it was taking.

Copies can also be obtained by contacting the Office of Public Affairs at Public.Affairs@oig.hhs.gov.

Download the complete report or the Report in Brief.

Office of Inspector General, U.S. Department of Health and Human Services | 330 Independence Avenue, SW, Washington, DC 20201