Florida and the Centers for Medicare & Medicaid Services (CMS) need to determine whether the state should repay the federal government for $12 million in Medicaid overpayments, the Department of Health and Human Services' Office of the Inspector General (OIG) recommends in a new report.
Florida's Agency for Health Care Administration (AHCA), which operates Medicaid, and the Department of Children and Families (DCF) did not return the federal portions of about $22 million in Medicaid overpayments found or collected between July 2007 and 2010, according to the OIG.
Florida has recouped only about $4 million of that $22 million over the course of several years, and has not returned any to CMS, largely due to a lack of coordination between the AHCA and DCF, which had originally performed eligibility determinations and overpayment reports, the OIG found in an audit.
The OIG has recommended that Florida pay CMS about $2.4 million of the federal share of overpayments collected between 2007 and 2012, improve coordination between the two departments and work with CMS to determine whether it needs to pay the $10 million in federal Medicaid dollars identified as overpayments but not collected.
In response to the OIG's findings, the ACHA said the amount of overpayments was accurate but questioned whether the state should have to repay CMS beyond $2.4 million.
The overpayments resulted from Medicaid recipients becoming ineligible for services after an eligibility determination was made and legitimate services were provided. "In other words," the agency wrote, "the overpayments addressed in this audit were not caused by provider misconduct, fraud, or abuse; the overpayments were the result of recipient eligibility errors and enrolled recipients transitioning in and out of Medicaid eligibility."
Repaying the full $12 million of the federal government's portion of overpayments would, the agency argued, "create a disincentive for the state to continue benefit recoveries from recipients later found to be ineligible for a variety of reasons and/or due to error, and would incentivize state policymakers and lawmakers to halt or limit related benefit recoveries from recipients and restrict Medicaid eligibility controls."