Corporate Compliance

GOV’T AUDIT INSIDER: Missouri cost reporting complies with federal standards

Healthcare Auditing Weekly, February 8, 2005

Missouri's Division of Medical Services, a program within the state's Department of Social Services, used correct methodology for identifying and reporting family planning services claims for federal fiscal years (FFY) 2001-2003, according to an OIG audit report. Missouri calculated family planning by multiplying total capitation payments by a factor determined by a third-party liability contractor. The factor equaled the family planning fee-for-service costs divided by total fee-for-service costs. The OIG has no recommendations and did the following during the audit:

  • Reviewed applicable sections of federal and state regulations

  • Evaluated the methodology used to compute the factor

  • Traced the costs included in the factor to actuarial, summary-level data

  • Verified whether the amounts in the factor identified as Medicaid family planning payments were allowable using the requirements of the CMS Guide

  • Verified that the amounts claimed for family planning on the expenditure reports for FFYs 2001-2003 were based on the correct application of the family planning factor applied to managed care payments reported on the expenditure reports

    Click here to read the audit report, "Managed Care Family Planning Claimed by Missouri," (A-07-04-1004) issued January 12.

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