Iowa Medicaid Payments for Skilled Professional Medical Personnel

EXECUTIVE SUMMARY:

Our objective was to determine if the Department of Human Services (State agency) properly claimed payments for skilled professional medical personnel at the enhanced Federal funding rate for FY 2003.  The State agency did not properly claim payments for skilled professional medical personnel at the enhanced Federal funding rate for FY 2003.  Specifically, the State agency claimed costs for personnel who did not meet the employer‑employee relationship requirements.  The State agency also improperly claimed costs and activities included in the University's and a school district's payment vouchers. 

We recommended the State agency:  (1) refund $671,759to the Federal Government; (2) ensure that direct medical services are claimed at the Federal Medical Assistance Percentage rate and not the enhanced administrative rate; (3) develop and implement policies and procedures to more closely monitor payments for skilled professional medical personnel; (4) provide training concerning how to properly complete the time studies to all staff of participating agencies; and (5) review FY 2003 payment vouchers submitted by all participating entities to ensure that activities included comply with Federal requirements, and remit the Federal share of any overpayments to the Federal Government.  The State agency did not fully concur with most of our findings and did not concur with three of the four recommendations.  The State agency stated that it "believes that [we] reviewed activities that took place in FFY 2003 in light of the more detailed federal guidance that went into effect AFTER the audit period."