Corporate Compliance

GOV'T AUDIT INSIDER: Improper Medicaid cost claims in Vermont

Healthcare Auditing Weekly, May 3, 2005

Vermont improperly claimed $262,219 in Medicaid costs related to skilled professional medical personnel for federal fiscal year 2003, according to an OIG audit report. The state did not have adequate procedures in place to ensure that only eligible individuals and allowable expenses were claimed for enhanced federal funding or that all costs claimed were appropriate charges to the Medicaid program. The OIG recommends that Vermont refund $262,219 for the federal share of unallowable Medicaid costs and implement procedures to ensure that future claims are eligible for the enhanced federal funding rate.

During the audit, the OIG did the following:

  • Reviewed applicable federal and CMS guidelines

  • Reviewed Vermont agency procedures for claiming skilled professional medical personnel costs

  • Obtained supporting documentation from the state agency pertaining to the relevant paid claim

  • Interviewed individuals claimed as skilled professional medical personnel

    Click here to see the report, Audit of Medicaid Payments for Skilled Professional Medical Personnel Reimbursed at Enhanced Rates,"(A-01-04-00008) issued March 29.

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