Audit of Duplicate Capitation Payments Under Medicare and Medicaid Managed Care Programs in Florida

November 26, 2002

EXECUTIVE SUMMARY:

The objective of this audit was to determine if managed care organizations (MCO) in Florida received capitation payments under the Medicare and Medicaid programs for the same services provided to the same beneficiaries during concurrent enrollment periods.  We found that there were dually eligible beneficiaries concurrently enrolled in both Medicare and Medicaid MCOs.  Our audit indicated there is a need for CMS to work with the Florida Medicaid agency to ensure that both duplicate capitation payments as well as duplicate fee-for-service payments will not occur.  CMS generally concurred with our finding and recommendation.