Florida Made Almost $4 Million in Unallowable Capitation Payments for Beneficiaries Assigned Multiple Medicaid ID Numbers

The Agency for Health Care Administration (Florida) made unallowable capitation payments on behalf of beneficiaries who were assigned multiple Medicaid identification (ID) numbers. Of the 100 beneficiary matches in our sample, Florida correctly made capitation payments on behalf of 1. However, it incorrectly made capitation payments that totaled $383,487 ($232,520 Federal share) on behalf of the remaining 99. The unallowable payments made on behalf of these beneficiaries occurred because Florida needed a significantly more complex matching algorithm than the one that it already had in place to identify beneficiary matches that existed in its system. For example, the name matching criteria were not strong enough to detect or prevent the additional Medicaid ID numbers for those beneficiaries with existing Medicaid ID numbers. Furthermore, Florida stated that newborn Medicaid ID numbers were duplicated when the demographic information used to update Department of Children and Families’ FLORIDA system for newborns was different from the demographic information (supplied by a provider or a managed care organization (MCO)). Florida used this information to initially activate the newborns’ records in the Florida Medicaid Management Information System.

On the basis of our sample results, we estimated that Florida made unallowable capitation payments totaling at least $6.5 million ($3.9 million Federal share) on behalf of beneficiaries with multiple Medicaid ID numbers during our audit period.

Read the Full Summary https://go.usa.gov/xdSHQ
Read the Report https://go.usa.gov/xdSHP

Source: Million in Unallowable Capitation Payments for Beneficiaries Assigned Multiple Medicaid ID Numbers / U.S. Department of Health and Human Services Office of Inspector General

Leave a Reply

Your email address will not be published. Required fields are marked *