Seven States' Medicaid Claims for Medical and Ancillary Services Made on Behalf of of 21- to 64-Year-Old Residents of State-Operated Institutions for Mental Diseases

EXECUTIVE SUMMARY:

This final report provides the results of our seven-State review of Medicaid claims for medical and ancillary services made on behalf of 21- to 64-year-old residents of State-operated institutions for mental diseases (IMD).  A common objective of these audits was to determine if controls were in place to preclude States from claiming Federal Medicaid funds for medical and ancillary services (except inpatient acute care hospital services) provided to 21- to 64-year-old residents of State-operated IMDs.  We found that three States (Maryland, Texas, and Virginia) had no controls to prevent Federal funding from being claimed, one State (New Jersey) had ineffective controls, two States (New York and Florida) had generally adequate controls, and one State (California) had efficient controls and made no improper claims.  The remaining six of the seven States improperly claimed a total of $2,466,190 in Federal Medicaid funds during various audit periods.