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Report says state agency made improper SPMP claims

Healthcare Auditing Weekly, December 9, 2008

The OIG reported that the New Hampshire Office of Medicaid Business and Policy did not submit proper claims for skilled professional medical personnel (SPMP).

The federal government reimburses state Medicaid programs at a matching rate of 50% for administrative costs. However, the government pays an enhanced matching rate of 75% for compensation and training of SPMP and their supporting staff, according to the OIG’s report. SPMP are physicians, dentists, nurses, and other specialized personnel who have completed at least two years of professional education and training in the field of medical care or appropriate medical practice.

In its report, the OIG found the state agency made $4,944,842 in SPMP claims in fiscal years 2005 and 2006, but $1,091,343 was not allowable. The improper claims were for:

• Personnel functions and other expenses not reimbursable at the enhanced rate
• Personnel who did not meet the education requirements

 The OIG recommends the state agency:

• Refund to the federal government $1,091,343 for the federal share of personnel, travel, and other operating costs that were improperly claimed at the enhanced rate
• Implement policies and procedures to ensure that future claims for costs related to SPMP are eligible for funding at the enhanced rate
• Develop a CMS-approved methodology to allocate costs for personnel whose time and effort are split between different functions

 The state agency generally disagreed with the OIG’s findings.

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