Nursing Homes and Denial of Payment Remedies in the State of Florida

EXECUTIVE SUMMARY:

The objectives of this audit were to evaluate whether State controls were adequate to prevent improper Medicaid payments to nursing homes under the denial of payment remedy, and ensure the mandatory denial of payment remedy for substandard quality of care was applied in nursing homes that were not in substantial compliance with the prescribed Medicaid participation requirements.  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 $176,853 ($99,957 Federal share) to sanctioned nursing homes.  We recommended a financial adjustment and implementation of additional procedures to ensure payments to provider are suspended timely.  In response, the State agreed that $135,397 of the $176,853 ($99,957 Federal share) recommended for adjustment was unallowable.  They concurred with our recommendation for implementation of additional procedures.