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Report File
Date Issued
Submitting OIG
Department of Health & Human Services OIG
Other Participating OIGs
Department of Health & Human Services OIG
Agencies Reviewed/Investigated
Department of Health & Human Services
Components
Centers for Medicare and Medicaid Services
Report Number
A-06-19-09005
Report Type
Audit
Location

NM,
United States

Number of Recommendations
6
Questioned Costs
$12,422,181
Funds for Better Use
$0
External Entity
New Mexico Human Services Department

Open Recommendations

This report has 6 open recommendations.
Recommendation Number Significant Recommendation Recommended Questioned Costs Recommended Funds for Better Use Additional Details
22-A-06-045.01 No $12,422,181 $0

We recommend that the New Mexico Human Services Department refund $12,422,181 to the Federal Government.

22-A-06-045.02 No $0 $0

We recommend that the New Mexico Human Services Department work with CMS to determine the appropriate amount of the additional $750,811 that it should have claimed and refund the Federal share difference.

22-A-06-045.03 No $0 $0

We recommend that the New Mexico Human Services Department establish policies and procedures to account for adjustments MCOs make to IHS encounter data after reconciliations are completed.

22-A-06-045.04 No $0 $0

We recommend that the New Mexico Human Services Department use the entered date to determine whether the MCO submitted an encounter within the 2-year limit.

22-A-06-045.05 No $0 $0

We recommend that the New Mexico Human Services Department turn on the edit for encounter data that compares calculated days to paid days to limit the State agency’s acceptance of encounter data with dates-of-service spans that do not support the paid days.

22-A-06-045.06 No $0 $0

We recommend that the New Mexico Human Services Department strengthen the edit by removing the 3-day allowance to ensure that dates-of-service spans fully support paid days.

Department of Health & Human Services OIG

United States