Department of Health and Human Services

Office of Inspector General -- AUDIT

Complete Text of Report is available in PDF format (780 kb). Copies can also be obtained by contacting the Office of Public Affairs at 202-619-1343.

EXECUTIVE SUMMARY:

For the quarters ended June 2004 through March 2007, the North Carolina Department of Health and Human Services, Division of Medical Assistance, did not claim Federal share for Medicare Part B premiums that it paid on behalf of some Medicaid beneficiaries (buy-in) in accordance with Federal requirements.  The Social Security Act allows States to use Medicaid funds to pay Medicare Part B premiums on behalf of certain persons eligible for both Medicare and Medicaid.  Of the $722 million that the State claimed, $698 million was eligible for Federal share, and approximately $24 million (approximately $16 million Federal share) was for beneficiaries in buy-in eligibility categories that were ineligible for Federal share.

We recommended that the State (1) refund to the Federal Government the $16 million incorrectly claimed for Federal share for Part B premiums, (2) perform a review of claims after the end of our audit period and refund any unallowable Federal share, and (3) develop adequate internal controls to ensure that Part B premiums claimed for Federal share are only for beneficiaries in eligible categories.  The State concurred with our finding and recommendations.