CMS overpaid Virginia $13.8 million in bonus payments related to its Children's Health Insurance Program and Medicaid programs, according to HHS' Office of Inspector General.
Three things to know:
1. While most of the data used to calculate the more than $60 million in bonus payments Virginia received during fiscal years 2011-13 followed federal requirements, OIG said Virginia improperly inflated its current enrollment by a fixed percentage estimate. The overstatement was meant to account for potential retroactive enrollment, instead of using actual enrollment numbers and adjusting the numbers to reflect actual retroactive enrollment.
2. Virginia officials confirmed to OIG that they added 7 percent to the state's current enrollment numbers in its bonus request for fiscal years 2011-13. However, the state didn't concur with OIG's recommended $13.8 million refund, claiming that CMS didn't provide adequate guidance or validate the numbers it submitted.
3. OIG stood by its findings: "The fact that CMS did not notify Virginia that it was submitting inaccurate enrollment calculations does not relieve the state of its responsibility to submit accurate calculations in accordance with published CMS guidelines," OIG said in a news release.
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