Audit of Medicaid Payments for Skilled Professional Medical Personnel Reimbursed at Enhanced Rates - West Virginia

The West Virginia Bureau for Medical Services (State agency) claimed and was reimbursed the Federal enhanced rate for 38 individuals improperly classified as skilled professional medical personnel. Those individuals did not meet the definition of 'skilled professional medical personnel' as defined in the Social Security Act and implementing Medicaid regulation. As a result, the State agency received Medicaid overpayments for fiscal year 2003 totaling $296,485 for individuals and $2,875 for non-compensation expenditures that did not meet the criteria of skilled professional medical personnel. We recommended that the State agency refund $299,360, and implement procedures to properly classify skilled professional medical personnel. The Centers for Medicare and Medicaid Services and State agency generally agreed with our findings and recommendations. However, the State agency reclassified 11 individuals who were claimed and reimbursed at the Federal enhanced rate for skilled professional medical personnel as Medicaid Management Information System operations personnel in order to retain the Federal enhanced rate.