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GOV’T AUDIT INSIDER: Overstated claims of family planning service costs in Maryland

Healthcare Auditing Weekly, July 5, 2005

Maryland overstated its claims of family planning service costs by $2.9 million between July 2000 and March 2004 because the state improperly claimed the costs under its Medicaid managed care program, according to an OIG audit report. By claiming these costs at the enhanced family planning rate rather than its regular federal share and by including ineligible costs in its family planning factor calculation, Maryland received $228,643 in unallowable federal reimbursement.

The OIG recommends that Maryland refund the federal share, apply the audited family planning factor of 1.33% for claims after March 2004, and refund the federal share of any overpayment.

During the audit, the OIG did the following:

• Reviewed applicable federal criteria and state laws and regulations

• Reconciled the total capitation payments made between July 2000 and March 2004 to those reported on Form CMS-64

• Reconciled the federal share claimed on Form CMS-64 to the federal share calculated using the family planning factor

• Reviewed the numerator and denominator components of the family planning factors to determine whether Maryland computed its factors according to its methodology

Click here to read the audit report, "Review of Family Planning Service Costs Claimed by Maryland's Medicaid Managed Care Program," (A-03-03-00218), issued May 26.

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