Audit of Medical and Ancillary Medicaid Claims for 21 to 64 Year Old Residents of State Psychiatric Hospitals That Are Institutions for Mental Diseases in Florida, Adoption and Foster Care, Administration for Children and Families (ACF)

EXECUTIVE SUMMARY:

The objective of this audit was to determine if the State of Florida had adequate controls to preclude claiming Federal financial participation (FFP) under the Medicaid program when 21 to 64 year old residents of State operated institutions for mental diseases (IMD) received physician services, laboratory and clinic services, or hospital outpatient treatment.  Our audit showed that the State of Florida appeared to have some controls in place at the IMDs to prevent improper FFP claims for medical and ancillary services provided to IMD residents.    We reviewed 262,796 claims totaling about $16 million in Medicaid payments, and found 5,745 claims that were not eligible for Federal reimbursement, yet FFP was claimed.  These claims represented $71,406 in FFP.  We recommended the State reimburse the Federal Government for the FFP share of the unallowable claims.