HHS IG Issues Audit Report on Federal Medicaid Reimbursement for Some Beneficiaries
The Patient Protection and Affordable Care Act gave States the option to expand Medicaid coverage to low-income adults without dependent children and established enhanced Federal reimbursement rates (Federal Medical Assistance Percentage, or FMAP) for services provided to beneficiaries enrolled through this group, known as the new adult group. Enhanced Federal reimbursement is defined as a payment made at a higher percentage than the State's standard FMAP rate. These higher FMAP rates raised concerns about States improperly enrolling individuals in the new adult group and the potential for improper payments.
Our objective was to determine whether
HOW OIG DID THIS REVIEW
Our review covered 1,357,665 beneficiaries enrolled in the new adult group and for whom
WHAT OIG FOUND
From our sample of 130 beneficiaries,
On the basis of our sample results, we estimated that
WHAT OIG RECOMMENDS AND
We recommend that
In written comments on our draft report,
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