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Review of South Dakota's Buy-In of Medicare Part B Premiums for Medicaid Beneficiaries from October 2008 Through September 2009

Our review of the Medicaid buy-in program (a provision of the Social Security Act that authorizes States to use Medicaid funds to pay the Medicare Parts A and B premium payments of eligible individuals) found that the South Dakota Department of Social Services (State agency) did not always comply with Federal requirements when claiming Medicaid reimbursement for Medicare Part B premiums it paid on behalf of eligible beneficiaries during FY 2009.

For the quarters ended October 2008 through September 2009, the State agency claimed Medicaid reimbursement of $300 (Federal share) for Medicare Part B monthly premiums from an unallowable retroactive period and overpaid its Medicare Part B Premium liability payment by $10,000 because of a Centers for Medicare & Medicaid Services billing error.

As a result, the State agency did not identify the error and subsequently claimed Medicaid reimbursement of $7,000 (Federal share) for Medicare Part B premium assistance that was in excess of the total Medicare premium liability of eligible beneficiaries in the November 2008 billing period. In addition, although the State agency had adequate controls to verify the eligibility of Medicaid buy-in beneficiaries, it did not adequately maintain the supporting fiscal records to document the eligibility status of those beneficiaries.

Filed under: Center for Medicare and Medicaid Services