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ST. LOUIS (AP) — An audit by the Federal Office of Inspector General says Missouri should pay back more than $21 million in federal Medicaid payments made to a state-operated children's hospital in St. Louis County.

The audit found that Hawthorn Children's Psychiatric Hospital failed for five years to fulfill regulatory requirements to qualify for the federal Medicaid reimbursements.

Missouri Department of Social Services spokeswoman Rebecca Woelfel says the department disagrees with the audit and will continue to defend its position. The state also filed a letter disagreeing with the finding.

The Office of Inspector General cannot require the state to pay back the money. The Centers for Medicare and Medicaid Services will decide whether to seek repayment of some or all of the money, and Missouri can appeal that decision.

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