Sneak Preview: Fla. Agency Assessing Cost Report Audit Frequency

January 26, 2012 | By Jerry Ashworth | Post a Comment

(The following was excerpted from an article in the Single Audit Information Service.) The Florida Agency for Health Care Administration plans to increase the frequency of its Medicaid cost report audits of health care facilities after the state’s Office of Auditor General determined that audits should be conducted more often to prevent potential improper payments and fraud.

Facilities such as hospitals, nursing homes and intermediate care facilities for the developmentally disabled receive Medicaid per diem rates based on annual cost reports that are submitted to the Florida AHCA. To comply with federal law, the agency hires independent contractors to periodically conduct audits of those cost reports to ensure that the amounts are accurate and complete. Florida law authorizes the agency to propose monetary sanctions or to suspend or terminate a facility’s participation in Medicaid for offenses such as submitting a cost report with materially false or incorrect information.

In a review of the cost report audits from September 2010 to May 2011 for 90 facilities, the state OAG found that hospitals were selected for audit an average of once every two-and-a-half years. Nursing home reviews were conducted once every five years and intermediate care facilities were reviewed once every six years. OAG determined that at those rates, it would take about 11 years for all of the nursing homes that participate in Medicaid to have an annual cost report selected for audit and 17 years for all intermediate care facilities to have an annual cost report selected for audit.

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