Audit of Nursing Homes and Denial of Payment Remedies - State of Illinois - October 1, 1999 Through September 30, 2001 - Illinois Department of Public Aid

EXECUTIVE SUMMARY:

The objectives of this audit were to determine whether mandatory denial of payment remedies for substandard quality of care was applied to nursing homes that were not in substantial compliance with the prescribed Medicaid participation requirements and to evaluate whether State controls were adequate to prevent improper Medicaid payments to nursing homes under the denial of payment remedy.  Our audit included denial of payment sanctions, which were in effect or should have been in effect from October 1, 1999 to September 30, 2001.   We found that the State permitted improper Medicaid payments for new admissions totaling $139,783 ($69,892 Federal share) to sanctioned nursing homes.  We recommended the State refund the reported overpayments and implement procedures to ensure payments to providers are suspended timely.  State agency officials agreed with the findings and recommendations.