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

Healthcare Auditing Weekly, July 12, 2005

Virginia over claimed Medicaid family planning service costs by $3.7 million between April 2001 and March 2004, receiving approximately $1.38 million in unallowable federal reimbursement, according to an OIG audit report. Virginia included the following ineligible costs in its family planning factor calculations: family planning service costs for beneficiaries not eligible to enroll in managed care and not represented in the denominator and services that did not qualify as family planning.

The OIG recommends that Virginia refund $1.38 million to the federal government and the federal share of overpayments, and apply the appropriate audit factors to its claims.

During the audit, the OIG did the following:

• Reviewed applicable federal criteria and state laws and regulations

• Reconciled the total capitation payments made between April 2001 and March 2004 to those reported on the CMS-64

• Reconciled the federal share claimed on the CMS-64 to the Federal share calculated using the family planning factors

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

Click here to read the audit report, "Review of Family Planning Service Costs Claimed by Virginia's Medicaid Managed Care Program," (A-03-04-00209), issued June 2.

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