Review of State Children's Health Insurance Program Payments in Puerto Rico

The Health Department overstated State Children's Health Insurance Program (SCHIP) expenditures on its fiscal year (FY) 2002 CMS 64.21U report by $28,301,865 (Federal share $18,396,212). Despite the reporting error, the overstatement did not have a financial impact on Federal funds. In addition, contrary to Federal regulations, the Health Department retained SCHIP expenditure data for as little as 6 months. Nothing came to our attention to indicate that improper SCHIP payments were made because of missing documentation. We recommended that the Health Department: (1) reduce expenditures reported on the FY 2002CMS 64.21U by $28,301,865 (Federal share $18,396,212), (2) establish procedures to reconcile SCHIP expenditures on its CMS 64.21U reports to the Commonwealth's Medicaid Development Information System to prevent any future overstatements, and (3) implement procedures for retaining records that comply with Federal regulations. The Health Department concurred with our findings and recommendations.