Evidence record
Analysis of Selected Medicaid Claims Data
- Jurisdiction
- Florida
- Publishing agency
- Florida Auditor General
- Publication date
- August 2020
- Source record
- Original document linked
Findings
1
Recommendations
1
Overall conclusion
Agency controls could be enhanced to better prevent or detect potential improper Medicaid claims payments.
Scope
The audit analyzed selected Medicaid claims data for the period July 2017 through March 2019, including FFS and SMMC program claims and encounter data, to evaluate internal controls, detect potential improper payments, and assess compliance with applicable laws, rules, and contracts.
Findings (1)
Each finding has a stable link.
- F-919
Medicaid Claims Payments - Pre-payment edits and post-payment reviews of Medicaid program claims are essential elements of a robust fraud and abuse prevention and detection program. The audit found that while the Agency establishes Medicaid policies and procedures, there were instances of potential improper Medicaid claims payments identified through analysis of selected FFS and SMMC claims data, including various claim types (controlled substances, HIV prescriptions, home health visits, dental services).
Recommendations (1)
- R-807
We recommend that Agency management enhance FMMIS and MCO oversight controls to better prevent or detect potential improper Medicaid claims payments.
Related finding F-919