Corporate Compliance

OIG: Vermont should refund $323,367 claimed for family planning services

Healthcare Auditing Weekly, January 24, 2006

The OIG has recommended that the state of Vermont refund $323,367 it received in improper claims for family planning services.

The OIG discovered the improper claims during an audit to determine whether the Vermont Agency of Human Services, Office of Vermont Health Access properly claimed federal financial participation for claims related to family planning services

The OIG found that from October 2003 through September 2004, the state agency improperly claimed a total of $323,367 for federal Medicaid reimbursement for family planning services.

The state agency claimed these costs because it did not reconcile the quarterly claims for enhanced reimbursement with paid claim activity for such services, and because it did not have adequate procedures in place to ensure that only eligible family planning-services were claimed for enhanced federal funding.

To perform the audit, the OIG:

  • reviewed laws and regulations related to family planning services

  • visited several family planning providers and discussed services provided to Medicaid recipients

  • reconciled the amounts claimed for federal reimbursement at the enhanced rate for family planning services on the state agency's quarterly Medicaid report (form CMS-64) with the state agency's supporting documentation

  • selected and reviewed a statistical sample of 100 paid claims classified as family planning services provided from October 1, 2003, through September 30, 2004

  • compared paid family planning service claim data with provider billing documentation supporting the claim

  • determined whether the reviewed services were authorized by the Vermont Medicaid state plan and reimbursed at the appropriate rate

  • obtained and reviewed medical records for the sample claims to confirm whether services provided were related to family planning

      Click here to read the audit report, "Audit of Vermont's Medicaid Payments for Family Planning Services Reimbursed at Enhanced Rates for the Period October 1, 2003 Through September 30, 2004," (A-01-05-00002) issued January 3, 2006.

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