Department of Health and Human Services

Office of Inspector General -- AUDIT

January 10, 2008

Complete Text of Report is available in PDF format (2.29 mb). Copies can also be obtained by contacting the Office of Public Affairs at 202-619-1343.

EXECUTIVE SUMMARY:

Our objective was to determine whether the State agency’s claim for Medicaid reimbursement of home and community-based services (HCBS) provided by Dungarvin during State fiscal year (SFY) 2005 complied with Federal and State requirements.  Of the 100 sampled beneficiary-months reviewed, the State agency claimed Medicaid reimbursement for services from 15 beneficiary-months that were unallowable because Dungarvin or Hennepin County did not adequately document the services in accordance with Federal or State requirements.

We recommended the State agency:  (1) refund $301,001 to the Federal Government, (2) require the Hennepin County office to strengthen its internal controls to ensure that it maintains individual service plans (ISPs) in accordance with Federal and State requirements and provides current ISP to Dungarvin, and (3) require Dungarvin to strengthen its internal controls to ensure it maintains ISPs, which includes the plans of care, in accordance with Federal and State requirements and documents and claims reimbursement for MRRC waiver services actually provided in accordance with Federal and State requirements.  The State agency did not address our first recommendation but agreed with the two other recommendations.