Corporate Compliance

GOV’T AUDIT INSIDER: Colorado claimed $1.1 million in unqualified family planning costs

Healthcare Auditing Weekly, February 15, 2005

Colorado's Department of Health Care Policy and Financing claimed more than $1.1 million that did not qualify for family planning costs for fiscal year (FY) 1999, resulting in $454,786 in excess Medicaid reimbursement, according to a January 13 OIG audit report. Since Colorado's reporting procedures have remained the same since 1999, a portion of the federal reimbursement the state received for FY 2000 to December 2003 may also be unallowable.

The OIG recommends that Colorado refund $454,786 to the federal government, ensure claims are accurate and reliable, and review the reimbursement received for family planning for FY 2000 to December 2003 for errors and refund unallowable costs.

During the audit, the OIG did the following:

  • Reviewed applicable sections of federal and state regulations

  • Interviewed Colorado officials regarding the policies and procedures used to identify family planning costs and submit claims

  • Reconciled the results of Colorado's family planning programs to the amounts claimed on the CMS-64

  • Verified the accuracy of the family planning reports by comparing claim data to the Medicaid Management Information System for specific claims

  • Verified the allowability of the claims shown on the family planning reports to the requirements of the CMS Guide

    Click here to read the audit report, "Fee-for-Service Family Planning Claimed by Colorado," (A-07-04-0 1008) issued January 13.

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