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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-02-21-01005
Report Type
Audit
Location

PR,
United States

Number of Recommendations
6
Questioned Costs
$7,864,945
Funds for Better Use
$0
External Entity
Puerto Rico Department of Health

Open Recommendations

This report has 6 open recommendations.
Recommendation Number Significant Recommendation Recommended Questioned Costs Recommended Funds for Better Use Additional Details
23-A-02-112.05 No $0 $0

We recommend that the Puerto Rico Department of Health develop written policies and procedures to use sources other than the Puerto Rico Demographic Registry to identify deceased enrollees.

23-A-02-112.03 No $0 $0

We recommend that the Puerto Rico Department of Health identify capitation payments made after the audit period on behalf of deceased enrollees and refund to the Federal Government the Federal share of any unallowable payments.

23-A-02-112.01 No $6,979,822 $0

We recommend that the Puerto Rico Department of Health refund $6,979,822 to the Federal Government.

23-A-02-112.06 No $0 $0

We recommend that the Puerto Rico Department of Health establish a process with ASES to ensure ASES ceases making payments to MCOs on behalf of enrollees after their deaths are recorded in DOH's eligibility system and recoups unallowable payments made on behalf of deceased enrollees.

23-A-02-112.04 No $0 $0

We recommend that the Puerto Rico Department of Health develop written policies and procedures to ensure that DOH staff periodically update, at least monthly, DOH's eligibility system with data on deaths recorded in the Puerto Rico Demographic Registry.

23-A-02-112.02 No $885,123 $0

We recommend that the Puerto Rico Department of Health identify capitation payments made on behalf of enrollees with a date of death in the DMF before the month covered by the capitation payments, estimated as $885,123 in Federal Medicaid funds, and refund to the Federal Government the Federal share of any unallowable payment.

Department of Health & Human Services OIG

United States