Unapproved allowances for institutionalized residents
Healthcare Auditing Weekly, August 30, 2005
New Mexico Human Services Department (the State agency) increased the monthly personal needs allowance for the state's institutionalized residents without seeking prior approval from CMS.
The unapproved increases, which occurred between July 1, 2001 through September 30, 2004, resulted in Medicare overpayments of $391,651, according to an OIG audit report.
The OIG recommends that New Mexico reimburse the $391,651 overpayment and ensure the state submits a state plan amendment when making Medicaid program changes, such as increasing the personal needs allowance for institutionalized individuals.
During the audit, the OIG did the following:
- Reviewed applicable state agency policies
- Reviewed the portion of the state plan related to the personal needs allowance to determine whether the state submitted required amendments
- Obtained the federal reimbursement percentages and the number of institutionalized residents affected by the unapproved increases
- Calculated the amount of improper payment
Click here to read the audit report, "Review of New Mexico's Personal Needs Allowance for Institutionalized Residents," (A-06-05-00034) issued July 18.
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