Department of Health and Human Services

Office of Inspector General -- AUDIT

"Medicaid Payments for Beneficiaries with Concurrent Eligibility in Michigan and Ohio - Michigan Department of Community Health," (A-05-06-00020)

August 28, 2006


Complete Text of Report is available in PDF format (698 kb). Copies can also be obtained by contacting the Office of Public Affairs at 202-619-1343.


EXECUTIVE SUMMARY:

The objective of our audit was to determine the appropriateness of Medicaid payments made by the State of Michigan for beneficiaries who were concurrently listed as Medicaid eligible in both Michigan and Ohio for the period October 1, 2002, through September 30, 2003.  We found that the Michigan Medicaid program inappropriately paid $843,228 for 617 Medicaid beneficiaries who had established eligibility in both States but should only have been eligible in Ohio.  We did not determine the allowability of an additional $100,575 of payments made during the first month of concurrent eligibility because Michigan considers the beneficiary eligible for the entire month once eligibility is established.

We recommended that the Michigan Department of Community Health (State agency):  (1) seek recovery of inappropriate payments, estimated to be $843,228 ($467,317 Federal share), and refund the Federal share of recovered amounts; (2) review claims made in the first month of concurrent eligibility and determine whether the payments are allowable; and (3) consider additional procedures for identifying beneficiaries moving out of State, including participation in the Public Assistance Reporting Information System (PARIS) project and increased sharing of eligibility information with the other State Medicaid programs.  Michigan officials agreed that they should not make Medicaid payments for beneficiaries who established residency in another State, but declined to seek recovery of the questioned costs.  We believe that the State agency can and should attempt to recover inappropriate Medicaid payments.