Corporate Compliance

Beneficiaries receive Medicaid benefits in two states

Healthcare Auditing Weekly, June 17, 2008

The Florida Agency for Health Care Administration (state agency) paid approximately $4.1 million for services to Medicaid beneficiaries who were receiving benefits in Florida and Georgia, according to an OIG audit.

Eligibility is based on state residency. If a beneficiary in one state moves to a different state, that state must re-determine the beneficiary’s eligibility.
 
The OIG found the state agency made these inaccurate payments during an audit period of July 1, 2005 to June 30, 2006. The OIG determined from its findings that the state agency paid $3,689,412 for beneficiaries who should not have been eligible because of their eligibility in Georgia. They also estimated that the state agency paid $28,169 on behalf of beneficiaries whose eligibility was undeterminable.
 
The OIG is recommending that the state agency work with the Georgia Medicaid agency to share eligibility information to:
  • Determine accurate beneficiary eligibility status
  • Reduce the amount of payments made on behalf of beneficiaries residing in Georgia
The OIG is also recommending the state agency work with CMS to determine the eligibility for the beneficiaries whose eligibility was previously not determinable.

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