Department of Health and Human Services

Office of Inspector General -- AUDIT

"Review of Missouri Medicare Part D Contributions to the Centers for Medicare & Medicaid Services for "Full-Duals,"" (A-07-07-01044)

June 23, 2008


PDF FileComplete Text of Report is available in PDF format (1.27 mb). Copies can also be obtained by contacting the Office of Public Affairs at 202-619-1343.


EXECUTIVE SUMMARY:

From January through December 2006, the Missouri Department of Social Services did not always make a corresponding contribution payment to the Centers for Medicare & Medicaid Services (CMS) on behalf of Medicaid recipients who were also eligible for Medicare (full-duals).  Federal regulations require States to make contribution payments to CMS to defray a portion of the costs of the Medicare Part D program.

Our review found that for 98 of 100 statistically sampled beneficiary-months, Missouri (1) was not required to make contributions to CMS because the beneficiaries were not actually full-duals in the sampled months or were not identified in the State’s Medicaid eligibility records or (2) made subsequent retroactive contributions to CMS.  However, contrary to Federal requirements, Missouri did not make contributions to CMS for 2 of the 100 sampled beneficiary-months.  Specifically, the State did not correctly identify either of the 2 beneficiaries as a full-dual.  As a result of the discrepancies, the State did not make $216 in contributions to CMS that it should have made.

We recommended that Missouri (1) remit $216 to the Federal Government on behalf of the two individuals who were not correctly identified as full-duals, (2) ensure that required contributions are identified and made for all full-duals, and (3) identify and accurately report all full-duals to CMS.  In written comments on our draft report, the State concurred with all of our recommendations.