Department of Health and Human Services

Office of Inspector General -- AUDIT

"Review of Abortion-Related Laboratory Claims Billed as Family Planning Under the New York State Medicaid Program," (A-02-05-01009)

July 24, 2007


PDF FileComplete Text of Report is available in PDF format (623 kb). Copies can also be obtained by contacting the Office of Public Affairs at 202-619-1343.


EXECUTIVE SUMMARY:

Our objective was to determine whether claims for abortion-related laboratory services for which New York State received Federal reimbursement at the enhanced 90-percent rate of Federal financial participation (FFP) qualified as family planning services. 

The State improperly received the enhanced 90-percent FFP rate for abortion-related laboratory services that did not qualify as family planning services.  In our opinion, 98 of the 100 claims in our sample did not qualify as family planning services.  As a result, we estimate that the State improperly received $3,235,640 in Federal Medicaid funds.  However, we have set aside this amount for consideration by the Centers for Medicare & Medicaid Services (CMS) and the State because no medical review was performed of the 100 sample claims. 

We recommended that the State (1) work with CMS to resolve $3,235,640 in set-aside claims, (2) reemphasize to all providers that abortion-related services are not considered family planning and the Medicaid claim form must be properly coded when an abortion-related service is provided, (3) strengthen systems to make use of all appropriate claim information to properly identify abortion-related laboratory claims that are ineligible for Federal funding, and (4) determine the amount of Federal Medicaid funds improperly reimbursed at the 90-percent rate for ineligible abortion-related laboratory services and work with CMS to determine the amount to be refunded to the Federal Government.  New York State concurred with our findings and recommendations.