Corporate Compliance

GOV’T AUDIT INSIDER: Nevada makes unallowable Medicaid claims for vaccine program

Healthcare Auditing Weekly, December 28, 2004

Nevada made $7,917 in potentially unallowable Medicaid payments to fee-for-service (FFS) providers for vaccines obtained at no cost through the Vaccines for Children (VFC) program during fiscal year 2003, according to an OIG audit report. The paid claims data that Nevada will use to establish future Medicaid managed care capitation rates included potentially unallowable payments for VFC vaccines and payments above the administration cap. The OIG recommends that Nevada implement controls to identify and prevent unallowable Medicaid payments to FFS providers for VFC vaccines and implement controls to identify and exclude unallowable Medicaid payments from the paid claims data. During the audit, the OIG did the following:

  • Held discussions with Center for Medicare & Medicaid Services and Center for Disease Control staff

  • Reviewed Nevada's state plan amendment, policies, and procedures related to the VCF program

  • Interviewed Nevada's key VCF program personnel

  • Reviewed related FY 2003 Medicaid FFS paid claims data and Medicaid managed care paid claims data

  • Reviewed other pertinent documents provided by Nevada

    Click here to read the audit report, "Audit of Nevada's Medicaid Payments for Vaccines Obtained Through the Vaccines for Children Program for Federal Fiscal Year 2003," (A-09-04-00048) issued November 19.

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