Corporate Compliance

GOV’T AUDIT INSIDER: Colorado overclaimed $1.5 million in family planning costs

Healthcare Auditing Weekly, April 19, 2005

Colorado received $1.5 million in overpayments that did not qualify for federal Medicaid reimbursement for the period October 1999 through December 2003, according to an OIG audit report. Colorado incorrectly claimed Medicaid family planning costs under managed care. The OIG recommended that Colorado refund the overpayments, ensure family planning costs are supported by accurate and reliable information, and verify the accuracy of family planning claims submitted for federal reimbursement.

During the audit, the OIG did the following:

  • Reviewed applicable laws, regulations, and policies

  • Interviewed Colorado officials

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

  • Verified the allowability of the claims shown on the family planning reports using the CMS guide

  • Verified the accuracy of the calculations Colorado made to determine its quarterly claims for federal Medicaid reimbursement

    Click here to read the audit report, "Family Planning Under Managed Care," (A-07-04-01005) issued March 24.

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