GAB Decision 496
Docket No. 83-208
January 6, 1984
Illinois Department of Public Aid;
Ballard, Judith; Ford, Cecilia Settle, Norval
The Illinois Department of Public Aid appealed a determination by the
Health Care Financing Administration that $2,127,206 in federal
financial participation (FFP) remained due to the Agency for certain
excess payments the State made to Medicaid providers and claimed as
expenditures under Title XIX of the Social Security Act. The Agency had
previously disallowed $4,824,026 based on an audit which reviewed the
State's accounts receivable records as of June 30, 1980, and found that
the State had not repaid the federal share of amounts identified by the
State as excess payments. In Illinois Department of Public Aid,
Decision No. 404, March 31, 1983, this Board upheld that determination,
finding that the State had received FFP in unallowable costs and
concluding that section 1903(d)(2) of the Social Security Act permitted
the Agency to adjust for this overpayment of FFP even if the State had
not yet recovered the excess payments from the providers. The Board
noted, however, that the State had raised doubts about the disallowance
amount. Therefore, while sustaining the disallowance, the Board
directed the Agency to review documentation submitted by the State
concerning the correct disallowance amount and to recalculate the
disallowance accordingly. The Board's decision stated that, if the
State disputed the accuracy of the recalculation, the State would have
an opportunity to appeal that determination to the Board.
Based on a subsequent review of State records, the Agency determined
that the State had repaid $2,696,820 of the federal share of the excess
payments as of June 30, 1983. Therefore, the Agency recalculated the
disallowance amount as $2,127,206. In its notice appealing the
recalculation, the State contended that the recalculation was incorrect.
Subsequently, however, the State agreed with the recalculations except
with respect to $50,000 which the State identified as still in dispute.
The State suggested initially that resolution of the issue of the
disputed amount by the Board seemed unnecessary since the State had
appealed Decision No. 404 to court (State of Illinois v. Heckler, U.S.
District Ct. S.D. Ill., No. 83 C 6789), and since the remaining dispute
(2) concerned such a small portion of the disallowance. When the Agency
objected to any delay in resolving the dispute, however, the State
suggested that the Board issue a decision, so long as it was clear that
any agreements by the State over the calculations should not be
construed as agreement with Decision No. 404.
With respect to the merits of the Agency's recalculation, the State
merely noted that it continued to dispute $50,000. As the Agency
pointed out in its response, the State did not specify what portion of
the disallowance this amount related to nor did it point to any specific
inaccuracy in the Agency calculations. The State had a further
opportunity to reply to this, but raised no substantive arguments in
support of its position concerning the $50,000. Therefore, there is no
basis on which we can conclude that the disallowance amount determined
by the Agency is incorrect, and we find no reason for further delaying a
decision.
Conclusion
Accordingly, we uphold the Agency's determination recalculating the
disallowance to be $2,127,206. This decision does not preclude the
Agency from voluntarily negotiating with the State concerning the
$50,000.
NOVEMBER 14, 1984