Department of Health and Human Services

Office of Inspector General -- AUDIT

Complete Text of Report is available in PDF format (443 kb). Copies can also be obtained by contacting the Office of Public Affairs at 202-619-1343.

EXECUTIVE SUMMARY:

Contrary to Federal requirements, Illinois did not contribute an estimated $2.1 million to CMS on behalf of the State’s “full-duals” from January through October 2006.  Full-duals are beneficiaries who are eligible for both full Medicaid benefits and Medicare.  Although Medicare subsidizes the Part D prescription drug benefit for full-duals, each State is required to make contributions.

The State made no contributions for 22 of the 300 sampled full-dual beneficiary-months.  Although the State’s monthly Medicare Prescription Drug, Improvement, and Modernization Act (MMA) file included full-dual information for 18 of the 22 beneficiary-months, CMS did not include the information in the MMA return file that identifies the amount billed to the State.  For the remaining four beneficiary-months, the State did not include full-dual information in its MMA file, nor did CMS in its MMA return file.  We recommended that the State (1) work with CMS to develop a process for reconciling the MMA file to the MMA return file to ensure that required contributions are identified and made for all full-duals and (2) identify and accurately report all full-duals to CMS in the MMA file.  The State concurred with the recommendations.