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GOV’T AUDIT INSIDER: Enhanced family planning rates claimed in Arizona

Healthcare Auditing Weekly, August 9, 2005

Arizona increased its claims of family planning services costs by $2.27 million between October 1999 and September 2002 by claiming these costs at the enhanced family planning rate of 90%, rather than its regular federal share, according to an OIG audit report. Arizona included an unsupported 11% component representing the health plans' administration, profit, and contingency expenditures in family planning rates used to determine managed care family planning services costs. As a result, Arizona's claim for federal reimbursement increased $558,093.

The OIG recommends that Arizona work with CMS to determine the eligibility of the enhanced federal share and ensure future rates be specifically identified and documented as related to family planning services.

During the audit, the OIG did the following:

• Reviewed applicable federal criteria and state laws and regulations

• Obtained copies of pertinent documentation

• Interviewed Medicaid personnel and CMS staff

• Analyzed Arizona's methodology for identifying the family planning service portion of the health plan capitation payments and to claim enhanced federal share

• Analyzed historical claim data

Click here to read the audit report, "Review of Enhanced Federal Share Claimed for Family Planning Services in Arizona During Federal Fiscal Years 2000, 2001, and 2002," (A-09-04-00027) issued July 6.

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