Review of Florida Medicaid Claims for 21 to 64 Year Old Residents of State Psychiatric Hospitals That Are Institutions for Mental Diseases

EXECUTIVE SUMMARY:

The objective of this review was to determine if the State of Florida had adequate controls to preclude claiming Federal financial participation (FFP) under the Medicaid Program when 21 to 64 year old residents of State operated institutions for mental diseases were transferred to acute care hospitals for inpatient treatment.  Our audit indicated that the State of Florida generally had adequate controls to prevent improper FFP claims in such cases.  We reviewed about 3,800 claims totaling about $19.8 million in Medicaid payments, and found only 47 claims that were not eligible for Federal reimbursement, yet FFP was claimed.  These claims represented $78,880 in FFP.  We recommended the State reimburse the Federal Government for the FFP share of the unallowable claims.