Missouri Claimed Unallowable Medicaid Payments for Individuals With Intellectual and Developmental Disabilities in Intermediate Care Facilities

We found that the Missouri Department of Department of Social Services (State agency) claimed unallowable Medicaid payments of $10.0 million ($7.2 million Federal share) during State fiscal year 2011. These unallowable payments consisted of $9.9 million ($7.1 million Federal share) that were the result of the same payments being claimed for Federal reimbursement during two different reporting quarters and $160,000 ($117,000 Federal share) in unsupported payments that we identified during our reconciliation of total expenditures claimed for Federal reimbursement to actual claims. These errors occurred because the State agency did not have adequate internal controls and procedures in place to prevent the claiming of unallowable Medicaid payments.

We recommended that the State agency (1) refund $7.2 million to the Federal Government and (2) develop and implement sufficient internal controls and procedures to prevent the claiming of unallowable Medicaid payments. The State agency partially agreed with our first recommendation; the State agency agreed with our second recommendation and described corrective action that it had implemented. Nothing in the State agency's comments caused us to change our findings or recommendations.