Federal report: Florida improperly documented prescribed medications to kids in foster care

by | Jul 28, 2023



  • The U.S. Department of Health and Human Services Office of the Inspector General (OIG) conducted an audit on Florida’s foster care system to assess the documentation of psychotropic and opioid medications prescribed to children in foster care.
  • The audit found significant deficiencies in the documentation of medications, indicating a lack of proper oversight and controls within the state’s child welfare information systems.
  • Among a representative sample of 115 children prescribed psychotropic or opioid medications, a large number of cases were not accurately documented in Florida’s Safe Families Network (FSFN).
  • The OIG made specific recommendations to improve medication oversight, including providing comprehensive training to child protective investigators and caseworkers on medication management and coordinating with the Florida Agency for Health Care Administration to access Medicaid data for children in foster care.

Florida’s foster care system was determined by the U.S. Department of Health and Human Services Office of the Inspector General (OIG) to have improperly documented psychotropic and opioid medications prescribed to children in foster care.

The OIG’s audit targeted Florida’s child welfare system and sought to evaluate compliance with state requirements regarding medication documentation for children eligible for assistance under Title IV-E of the Social Security Act.

The inspection examined a representative sample of 115 children who were prescribed psychotropic or opioid medications. In conducting the audit, OIG used Medicaid claim records, case files in Florida’s Safe Families Network (FSFN), and health care records.

The audit ultimately found that the state’s child welfare information systems failed to accurately document prescriptions for psychotropic and opioid medications prescribed to children in foster care, raising concerns about the effectiveness of medication oversight within the system.

“These documentation deficiencies occurred because the State agency did not have adequate controls to ensure the case managers maintained the children’s case files in FSFN in accordance with State requirements,” reads the audit. “Specifically, the State agency did not have adequate oversight procedures and training to ensure the Child Protective Investigators (CPI) and case managers documented psychotropic medications and maintained medication logs.”

Among the children prescribed psychotropic medications, 36 out of 85 were not recorded in FSFN. Further, medication logs for 56 children were omitted from the system entirely, and 33 children lacked necessary medical authorizations.

The situation was even more alarming for children prescribed opioid medications, where 57 out of 60 children had no record in FSFN.

In response to the findings, the Inspector General made specific recommendations to improve medication oversight and documentation. The state was urged to provide comprehensive training on medication management and administration to child protective investigators and caseworkers.

Additionally, the state was advised to coordinate with the Florida Agency for Health Care Administration to enable access to Medicaid data for children in foster care. According to a footnote, Florida officials elected to withhold comments on the draft report.

“We recommend that Florida provide training to CPIs and caseworkers on medication management and administration that addresses requirements for updating case records in FSFN for children who are prescribed psychotropic medications and opioid medications and coordinate with the Florida Agency for Health Care Administration to obtain access to Medicaid claim data for all children under its care and supervision,” wrote Amy J. Frontz, Deputy Inspector General for Audit Services.

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