Corporate Compliance

Florida Health Care Agency paid $3.7 million to ineligible Medicaid recipients

Compliance Monitor, June 17, 2008

The Florida Agency for Health Care Administration paid an estimated $3.7 million between July 1, 2005, and June 30, 2006 to Medicaid beneficiaries that had established residency in the state of Georgia, according to a report from the OIG. When a Medicaid recipient establishes residency in a different state, his or her eligibility in the previous state should be terminated.

The OIG made the estimate after reviewing a random statistical sample of 100-beneciciary months that totaled $76,617 in Medicaid services in the state. They found that 68 beneficiary-months were paid to people who should not have been eligible for Medicaid services in the state of Florida. They also found that seven months were paid to beneficiaries whose residency could not be determined based on documents the state produced.

The report blamed Georgia Medicaid agency for failing to share all Medicaid eligibility information their Florida counterpart. To prevent any future problems the OIG recommended the two state agencies share eligibility information, so they can determine accurate eligibility status and reduce the amount of payments.

The OIG also recommended the Florida agency work with CMS to determine the citizenship of the beneficiaries whose residency could not be determined based on state documents. Those beneficiaries received an estimated $28,160 over the same one-year period.

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