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Audit (A-07-11-01097)

10-05-2011
Review of Costs for Inpatient Services in the Colorado Medicaid Family Planning Program

Executive Summary

The Colorado Department of Health Care Policy and Financing (the State agency) did not always claim costs for family planning inpatient services during fiscal years (FY) 2006 through 2009 pursuant to Federal and State requirements. Of the 100 claims in our sample, 97 qualified as family planning services and were allowable for reimbursement at the enhanced 90-percent rate. However, the three remaining claims in our sample contained errors totaling $2,000 in unallowable Federal reimbursement. Specifically, two of the claims lacked proper consent for inpatient sterilization procedures and were therefore not allowable for any Federal reimbursement. The other claim was not allowable for Federal reimbursement at the enhanced 90-percent rate (but was allowable for Federal reimbursement at the Federal medical assistance percentage rate, which ranged from 50.00 to 61.59 percent for claims paid during FYs 2006 through 2009) because the service in question was not performed for a family planning purpose.

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