Follow-Up Review of the Health Care Financing Administration's Resolution of Improper Medicaid Claims for Patients Residing in Institutions for Mental Diseases

EXECUTIVE SUMMARY:

This final follow-up report points out that the Health Care Financing Administration's (HCFA) resolution actions were not adequate for 3 of 4 recommendations made in a prior report on improper Medicaid claims made by New York for patients residing in institutions for mental diseases. As a result, New York continued making such claims, which totaled approximately $19.6 million (Federal share) from January 1, 1991 through December 31, 1999. During our audit, New York implemented edits and controls which, if maintained, will prevent future improper claims. We recommended that HCFA issue New York a disallowance for the $19.6 million and instruct New York to compute and refund the Federal share of any unallowable claims made after December 31, 1999. The HCFA concurred.