Federal Reports

The Florida Agency for Health Care Administration (State agency) did not always suspend Medicaid payments to providers that had credible fraud allegation cases in accordance with the Social Security Act. Of the 95 cases that we reviewed, the State agency applied a good-cause exception not to suspend payments for 1 case; and it either suspended, pursued recovery, or otherwise did not make Medicaid payments to providers related to 40 other cases.

For Federal fiscal years 2010 through 2013, the California Department of Health Care Services (State agency) claimed $58.3 million in Federal reimbursement for Medicaid overpayments that it made to providers who were determined to be bankrupt or out of business (uncollectible overpayments). The State agency complied with Federal requirements when reclaiming Federal Medicaid reimbursement for uncollectible overpayments. However, the State agency incorrectly used increased Federal medical assistance percentages (FMAPs) authorized under the American Recovery and Reinvestment Act to claim additional Federal reimbursement of $6.6 million for uncollectible overpayments that were not originally made during the recession adjustment period (October 1, 2008, through June 30, 2011) or were not previously refunded to the Federal Government using the increased FMAPs.