Corporate Compliance

OIG: Ohio must pay back $142,964

Healthcare Auditing Weekly, December 20, 2005

The OIG has recommended that the Ohio Department of Job and Family Services refund Medicaid $142,964. An OIG audit determined that the state filed improper claims for reimbursement of skilled-professional-medical-personnel costs.

An OIG audit has determined that the agency improperly claimed enhanced reimbursement for skilled professional medical personnel costs and was overpaid $120,464 in federal funds.

These improper costs included

  • salaries and fringe benefits for 22 personnel lacking professional education and training

  • training and travel related to ineligible personnel

  • accounting costs not eligible for enhanced reimbursement

    Because of an accounting error in the state agency's second-quarter claim for federal reimbursement, the federal share was overstated by an additional $22,500. The state also claimed salary and fringe benefits for 138 individuals at the enhanced rate.

    The OIG also recommended that the state work with regional CMS officials to establish an appropriate portion of the $893,281 in enhanced funding associated with skilled professional medical personnel activities.

    To perform the audit, the OIG

  • reviewed applicable regulations and CMS guidance and state agency procedures

  • reviewed the state agency's supporting documentation for the relevant paid claims, and reviewed service contracts between the state agency and contracted agencies

  • interviewed state agency personnel and reviewed departmental documentation regarding job qualifications, classifications, and duties for individuals claimed as skilled professional medical personnel

  • judgmentally selected and interviewed 74 of the 219 contracted personnel and reviewed documentation regarding job qualifications, classifications, and duties for positions with significant skilled professional medical personnel claims

      Click here to read the audit report, "Audit of Ohio's Medicaid Payments for Skilled Professional Medical Personnel for the Period October 1, 2002 Through September 30, 2003," (A-05-04-00078) issued November 18, 2005.

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