Review of Medicaid Claims for Beneficiaries Under the Age of 21 Who Reside in Institutions for Mental Diseases in the Commonwealth of Virginia

EXECUTIVE SUMMARY:

This final report points out that Virginia's Department of Medical Assistance Services improperly claimed Federal financial participation (FFP) for medical services provided to institutions for mental diseases (IMD) residents under the age of 21.  In addition, Virginia did not maintain a complete listing of the residents in the IMD facilities.  The improper claims occurred because Virginia did not have controls in place to preclude FFP from being claimed for medical services provided to IMD residents under the age of 21.  Additionally, procedures were not adequate to identify all Medicaid eligible patients in the IMDs.  The improper claims totaled $3,948,532 (FFP).  Additionally, Virginia failed to identify 1,825 of the 5,571 residents included in our audit that were residents of IMD facilities.