Audit of Ohio's Medicaid Payments for Skilled Professional Medical Personnel for the Period October 1, 2002 Through September 30, 2003

EXECUTIVE SUMMARY:

The objective of the audit was to determine whether the Ohio Department of Job and Family Services (State agency) properly claimed Federal Medicaid funding at the enhanced rate for skilled professional medical personnel and their supporting staff for the period October 1, 2002, through September 30, 2003.  The State agency improperly claimed enhanced reimbursement for skilled professional medical personnel costs and was overpaid $120,464 in Federal funds.  These improper costs included (1) salaries and fringe benefits for 22 personnel lacking professional education and training, (2) training and travel related to ineligible personnel, and (3) accounting costs not eligible for enhanced reimbursement.  Because of an accounting error in the State agency's second-quarter claim for Federal reimbursement, the Federal share was overstated by an additional $22,500.  The State also claimed salary and fringe benefits for 138 individuals at the enhanced rate.

We recommended that the State agency:  refund $142,964 for the overpayments and accounting error; work with CMS officials to establish the appropriate portion of the $893,281 in enhanced funding that is associated with skilled professional medical personnel; implement procedures to ensure that future claims include only qualified costs; and identify and refund the Federal share of Medicaid overpayments for skilled professional medical personnel claimed after September 30, 2003.  In a written response, Ohio officials disagreed with the recommended refund of salary costs.  Based on the comments, we revised our recommendations to set aside $893,281 for CMS to adjudicate.