Federal Reports

Georgia made capitation payments on behalf of beneficiaries who were assigned multiple Medicaid identification (ID) numbers. Of the 100 beneficiary matches in our sample, Georgia correctly claimed reimbursement for capitation payments on behalf of 28. However, Georgia incorrectly claimed multiple capitation payments that totaled $201,561 ($132,765 Federal share) on behalf of the remaining 72. Of the 72 beneficiary matches that had multiple capitation payments within our audit period, 48 had additional payments that were outside of our audit period and totaled $192,101 ($126,488 Federal share). The improper payments made on behalf of these beneficiaries occurred because Georgia used several systems to input and assign Medicaid ID numbers to beneficiaries but did not properly identify when beneficiaries had multiple Medicaid ID numbers. On the basis of our sample results, we estimated that Georgia made unallowable capitation payments between July 1, 2011, and June 30, 2014, totaling at least $821,295 ($540,984 Federal share) on behalf of beneficiaries with multiple Medicaid ID numbers.

The objective of this audit was to determine whether internal controls were in place and effective for making local purchases and payments at the Summerland Key, FL, Post Office.

Este informe asistiremos a los beneficiarios y sub¬-beneficiarios de las subvenciones de asistencia por desastre de la Agencia Federal para el Manejo de Emergencias (FEMA) a: documentar y contabilizar los costos relacionados con el desastre; minimizar la pérdida de los fondos de asistencia por desastre de FEMA; maximizar la recuperación financiera; y prevenir el fraude, malversación y abuso de los fondos de desastre. El informe revisado es efectivo para todas las emergencias y desastres mayores declarados a partir del 1 de abril de 2017.The English version of this report can be found at: https://www.oig.dhs.gov/sites/default/files/assets/2017/OIG-17-120-D-Se…

Tennessee did not always stop making capitation payments after a beneficiary's death, despite its efforts to identify and recover any unallowable payments. Of the 120 capitation payments in our random sample selected from payments for beneficiaries whose dates of death (DODs) preceded the payment dates, Tennessee recovered 43 prior to the start of our audit, and 13 were not recoverable. For the remaining 64 payments, Tennessee made unallowable payments totaling $39,909 ($27,357 Federal share). During our audit, Tennessee adjusted 35 of the 64 payments totaling $23,614. On the basis of our sample results, we estimated that Tennessee made overpayments to managed care organizations (MCOs) totaling $2.7 million ($1.8 million Federal share) during our audit period. These unallowable payments amount to less than 1 percent of the $3.8 billion that the Tennessee paid to MCOs from July 1, 2009, through March 4, 2016.