Kansas Loses Estimated $88 Million in Medicaid Revenues Due to Non-Compliance in Quality Care Assessments

By Trish Svoboda

A performance audit conducted by Kansas Medicaid Inspector General Steven D. Anderson uncovered that Kansas had an estimated loss of around $88 million in Quality Care Assessment revenues and interest.

Quality Care Assessments are fees paid by skilled nursing facilities to the state for Medicaid reimbursement and are matched by federal funds.

The performance audit indicated that the Kansas Department of Insurance erroneously granted continuing care provider certificates to multiple facilities without meeting statutory requirements, resulting in significant losses in Quality Care Assessment revenue for the state. Between July 1, 2020, and August 31, 2023, the audit found that 68% of Continuing Care Provider certifications were non-compliant with state laws due to providers failing to fulfill statutory obligations, such as undergoing an annual audit.

The report disclosed that 24% of Quality Care Assessments were wrongly assigned to facilities not meeting the criteria as genuine continuing care providers, resulting in a reduced rate. These facilities lacked the ability to offer a continuum of care and appeared to provide only one level of care.

Due to these facilities paying the lower rate, the state had to use over $33 million in State General Funds to make up for lost revenue and access full federal matching funds. Moreover, these facilities failed to submit annual audit reports, contributing to the estimated $88 million revenue loss.

The audit report presents numerous findings and recommendations aimed at enhancing oversight of the Continuing Care Provider registration process. If these recommendations are adopted, they have the potential to save the state of Kansas millions of dollars annually

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