Escambia County has uncovered a summary report from the office of State of Florida Auditor General David W. Martin outlining significant flaws related to the prevention and detection of improper Medicaid payments by the Agency for Health Care Administration (AHCA). Escambia County staff was assisted in these efforts by representatives from the offices of Escambia County Clerk of Court and Comptroller Ernie Lee Magaha.
The Auditor General’s report supports Escambia County’s position that HB 5301 forces the state’s 67 counties to submit to a system of wasteful, inaccurate and ineffective Medicaid reimbursements without providing a viable method to dispute erroneous claims. The Audit was released on October 31, 2011 – five months prior to the enactment of HB 5301 – and shows the State of Florida was aware of AHCA’s systemic history of overpayments, payment errors and lack of oversight relating to the payment of Medicaid claims. Further, the report states that AHCA has shown significant limitations in providing necessary oversight. Any attempt by the counties to provide local auditing of disputed claims has been rendered moot by the passage of HB 5301.
Among the most disturbing findings of the State Auditor’s report are:
* A sampling of 286 claims that resulted in a finding that 63.6% of claims reviewed exceeded allowable and authorized limits. The Auditor’s report estimated the total amount of outpatient hospital crossover overpayments to be approximately $117.6 million over a three-year period.
* The audit revealed that AHCA had not correctly calculated professional Medicare crossover claims resulting in overpayments totaling more than $14 million. Additionally, overpayments of more than $26 million for Medicare crossover claims were made without regard to whether or not the recipient was eligible for the assistance.
* AHCA possesses an ineffective risk assessment process which has contributed to the disbursement of improper payments. The State Auditor’s analysis of service types and procedure codes revealed payment errors in excess of $17.2 million to durable medical equipment and other service providers.
* AHCA did not dispute – and in some cases even agreed – with these assessments in a response to the State Auditor’s report dated October 21, 2011.
The findings outlined by the State of Florida’s own Auditor General, clearly represent a significant and avoidable loss to the taxpayers of the State of Florida and, by extension, the residents of Escambia County. Here is the report: AHCA AG reports.