Federal Reports

First Coast Service Options, Inc., a Medicare contractor, did not claim $740,000 of allowable Supplemental Executive Retirement Plan costs for fiscal years 2006 through 2009.

The Massachusetts Executive Office of Health and Human Services, Office of Medicaid (State agency), did not comply with Federal waiver and State requirements for critical incidents involving developmentally disabled Medicaid beneficiaries. Specifically, the State agency did not ensure that (1) group homes reported all critical incidents to the Department of Developmental Services (DDS), (2) DDS obtained and analyzed data on all critical incidents, (3) appropriate action steps were identified in all incident reports that could prevent similar critical incidents, and (4) DDS always reported all reasonable suspicions of abuse or neglect to the Disabled Persons Protection Commission (DPPC).

The Alabama Medicaid Agency (State agency) claimed school-based Medicaid administrative costs that were not in accordance with Federal requirements. It claimed these costs without submitting for Division of Cost Allocation review its public assistance cost allocation plan (CAP) and certain amendments and, consequently, without having an approved CAP. Instead, the State agency claimed costs based on various versions of its implementation guides and plans that were being considered by and negotiated with CMS. In addition, the State agency used statistically invalid random moment sampling (RMS) in allocating costs to Medicaid, and it did not maintain adequate support to validate its sample results and related extrapolations. As a result, the almost $150.5 million (almost $75.3 million Federal Financial Participation) the State agency claimed in school-based Medicaid administrative costs for FFYs 2010 through 2012 was unallowable. The State agency attributed its lack of compliance with Federal requirements regarding submission of the CAP to staff turnover and a lack of knowledge of Federal requirements.

The Alabama Medicaid Agency (State agency) did not comply with Federal and State requirements for claiming $209.5 million ($162.5 million Federal share) in certified public expenditures (CPEs) for Federal fiscal year 2010. The State agency incorrectly claimed $27.5 million ($21.3 million Federal share) because it made errors in its CPE calculation.

This report provides a summary of our investigative findings in cases involving administrative misconduct.