This final audit report points out that the State agency had not refunded $2.9 million (Federal share) of Medicaid overpayments made to 75 Intermediate Care Facilities for the Mentally Retarded (ICFs/MR) between October 1, 1985 and August 31, 1991. The overpayments were the result of State agency audit findings which adjusted the per diem rates used to reimburse providers for Medicaid ICF/MR services. The audit adjustments which were applied retroactively, effectively decreased the providers' per diem rates. We recommended policy changes, procedural improvements and a financial adjustment for $2.9 million. Regional Health Care Financing Administration officials concurred with our findings and recommendations.