Review of Medicaid Long-Term Nursing Care Payments for Individuals with both Medicare and Medicaid Coverage

EXECUTIVE SUMMARY:

The objective of this audit was to determine whether the Florida Agency for Health Care Administration (Agency) inappropriately made Medicaid payments for nursing facility care for dually eligible beneficiaries while CMS also made Medicare SNF payments.  We found that the Agency generally made proper Medicaid payments for dually eligible beneficiaries residing in a SNF.  The Agency relies on the nursing facilities to provide appropriate Medicare SNF admission and discharge information on the claims submitted.  The Agency recently implemented a procedure to match Medicare payment data to Medicaid nursing home payments to identify potential errors.