Federal Reports

The Centers for Medicare & Medicaid Services (CMS) has not issued guidance instructing States on the appropriate extent and timing of Medicaid withdrawals. Specifically, CMS has not issued guidance that clarifies the "as needed" language in 42 CFR § 430.30(d)(3) that would educate States on the application of 31 CFR part 205 in Medicaid. Such guidance and education would help prevent States from withdrawing more Medicaid funds than necessary. All three States that we audited withdrew more funds than necessary to meet immediate cash needs. At the time of our reviews, Alabama and Maryland had overdrawn more than $130 million in Medicaid funds that they had not refunded to the Federal Government. Although Illinois refunded overdrawn Medicaid funds, its withdrawals exceeded its expenditures by an average of $60 million a quarter.

The payments that First Coast Service Options (FCSO) made to providers in Jurisdiction N (Florida, Puerto Rico, and the U.S. Virgin Islands) for hospital outpatient dental services generally did not comply with Medicare requirements. Of the 100 dental services in our stratified random sample, 95 did not comply with Medicare requirements. Using our sample results, we estimated that FCSO improperly paid providers in Jurisdiction N at least $1 million from January 1, 2012, through August 31, 2014.

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