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Audit (07-11-04178)

10-04-2011
Review of Costs Claimed for Selected High-Dollar Outpatient Services in the Colorado Medicaid Program During the Period January 1, 2007, Through December 31, 2009

Executive Summary

The Colorado Department of Health Care Policy and Financing (the State agency) did not always claim costs for selected high-dollar outpatient service claims during calendar years 2007 through 2009 pursuant to Federal and State requirements. We referred to outpatient services whose claims included at least one line item paid amount greater than $10,000 as "high-dollar outpatient service claims." Of the 278 high-dollar outpatient service claims that the State agency claimed for payments it made to providers during the audit period, 239 were allowable. For the remaining 39 high-dollar outpatient service claims, providers reported incorrect charges and could not provide documentation to support that some of the outpatient services were provided. This resulted in overpayments totaling $273,000 ($149,000 Federal share).

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