Evidence record
South Carolina Did Not Report Approximately $108.6 Million of the Federal Share of Medicaid and CHIP Collections Subject to the Increased COVID-19 Federal Medical Assistance Percentage
- Jurisdiction
- South Carolina
- Audit organization
- Department of Health and Human Services, Office of Inspector General, Office of Audit Services
- Publication date
- September 2026
- Source record
- Metadata record
Findings
5
Recommendations
4
Overall conclusion
The OIG determined that South Carolina did not accurately calculate and report the Federal share of Medicaid and CHIP collections subject to the increased COVID-19 FMAP during the audit period, resulting in underreporting of the Federal share (approximately $99.98 million, plus $8.59 million for the first quarter) and an overall overpayment of about $108.6 million to the State agency; lack of written policies and procedures contributed to reporting errors, prompting four recommendations to strengthen controls and FMAP-change handling.
Scope
Audit period January 1, 2020 through March 31, 2025; reviewed South Carolina Department of Health and Human Services' reporting of the Federal share of Medicaid and CHIP collections on CMS reports (CMS-64 and CMS-21) and reconciled to accounting records, with emphasis on the increased COVID-19 FMAP period.
Findings (5)
Each finding has a stable link.
- F-1396
The State agency did not accurately calculate and report the Federal share of approximately $108.6 million in collections subject to the increased COVID-19 FMAP during the audit period.
- F-1397
With the exception of the first quarter in which the increased COVID-19 FMAP applied, the State agency calculated and recorded the Federal share of these collections in its accounting records but underreported about $100 million of the Federal share on CMS reports.
- F-1398
The State agency did not calculate and accurately report the increased COVID-19 Federal share of collections it received during the first quarter that the increase applied (quarter ended March 31, 2020), calculating a Federal share of about $8.6 million that should have been reported.
- F-1399
These errors occurred because the State agency lacked written policies and procedures for preparing CMS reports and reconciling to accounting records.
- F-1400
As a result, the Federal Government overpaid the State agency approximately $108.6 million for the audit period.
Recommendations (4)
- R-1247
Adjust future CMS reports to reflect the Federal share of $99,983,506 in underreported collections during the audit period and refund this amount.
Related finding F-1397 - R-1248
Adjust future CMS reports to reflect the Federal share of at least $8,592,050 in collections that were not appropriately calculated and reported during the first quarter of the increased COVID-19 FMAP period and refund this amount.
Related finding F-1398 - R-1249
Develop and implement written policies and procedures to report the actual amounts from accounting records on the CMS reports and reconcile accounting records to the amounts of Medicaid collections it reports on the CMS reports.
Related finding F-1399 - R-1250
Establish and implement written policies and procedures to appropriately calculate the Federal share of Medicaid collections during periods with unexpected or retroactive FMAP changes.
Related finding F-1399