Colorado could owe Medicaid $481,000
Healthcare Auditing Weekly, March 4, 2008
The Colorado Department of Health Care Policy and Financing might owe the federal government as much as $481,000 for reimbursement claims submitted in fiscal years 2003 and 2004, an OIG audit found.
The state agency claimed $21,678 for drug products that were not eligible for Medicaid coverage because they were terminated drugs. An additional $459,604 represents expenditures for drug products not listed on the quarterly drug tapes. Because the state agency did not verify whether the drugs missing from the tapes were eligible for Medicaid coverage, these drug expenditures may not be allowable for Medicaid reimbursement.
The OIG recommended the state agency:
- Refund $21,678 to the federal government for drug expenditures that were not eligible for Medicaid coverage
- Work with CMS to resolve $459,604 in payments for drugs that were not listed on the quarterly drug tapes and that may not have been eligible for Medicaid coverage
- Strengthen internal controls to ensure that claimed Medicaid drug expenditures comply with federal requirements
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