Review of Medicaid Fee-for-Service Payments for Beneficiaries Enrolled in Medicare Managed Care

EXECUTIVE SUMMARY:

The objective of this audit was to determine whether Ohio made unallowable Medicaid fee-for-service (FFS) payments for beneficiaries enrolled in Medicare managed care organizations (MCO).  Based on a statistical sample of 200 claims, we estimated that the Ohio Department of Job and Family Services paid unallowable Medicaid claims totaling $4.6 million ($2.7 million Federal share) for services covered by Medicare MCOs during the fiscal year ended June 30, 2001.  The State's processing system for Medicaid claims did not have controls to prevent payment of FFS claims for services covered by Medicare managed care.  We recommended financial adjustments and improvements to internal controls.