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Some of the State-Operated Medicaid Program Expenditures Claimed by Missouri During the Period October 1, 2010, Through June 30, 2012, Were Unallowable

For the State-operated Medicaid programs that were the subject of this review, most of the Missouri Department of Social Services, Missouri HealthNet Division's (State agency) claims for Federal reimbursement during our audit period were properly supported by actual expenditures in accordance with Federal requirements and guidelines. However, the State agency incorrectly claimed State-operated program expenditures totaling $361,000 (Federal share) during this period.

Our term "State-operated programs" refers to several specialized assistance programs within Missouri's Medicaid program that are administered, not by private providers, but rather by various departments of the Missouri State Government; this review focused on three such programs. The departments of the Missouri State Government that administer these programs bill their program expenditures to the State agency, which in turn claims those expenditures for Federal reimbursement.

The overpayments occurred because of inadequacies in the State agency's procedures for claiming these expenditures. Specifically, and contrary to Federal regulations and Centers for Medicare & Medicaid Services guidelines, the State agency's procedures permitted it to use estimates when claiming State-operated program expenditures. The $361,000 (Federal share) exceeded the amount that the State agency determined was allowable for these expenditures.

Filed under: Center for Medicare and Medicaid Services