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Audit (A-06-10-00047)

05-25-2011
Review of Medicaid Hysterectomy Expenditures Claimed as Family Planning in Oklahoma for Calendar Years 2005 to 2009

Executive Summary

Of the $18.2 million in hysterectomy expenditures that the Oklahoma Health Care Authority (State agency) claimed from January 1, 2005, through December 31, 2009, it improperly claimed $17.4 million at the enhanced family planning Federal Medical Assistance Percentage (FMAP) of 90 percent. As a result, the State agency inappropriately received an additional $3.4 million (Federal share).

The Federal Government pays its share of a State's medical assistance expenditures under Medicaid based on the FMAP, which varies depending on the State's relative per capita income. The FMAP for family planning expenditures is 90 percent, which is higher than the regular FMAP. The Federal Government pays its share of hysterectomy expenditures at the regular FMAP.

We recommended that the State agency (1) refund to the Federal Government the $3.4 million in overpayments that it received for hysterectomy expenditures claimed at the enhanced family planning FMAP, (2) refund to the Federal Government any overpayments that it may have received for hysterectomy expenditures claimed at the enhanced family planning FMAP in quarters after our audit period, and (3) discontinue claiming hysterectomy expenditures at the enhanced family planning FMAP. The State agency agreed with our finding and stated that it had removed all hysterectomy billing codes from the list of family planning codes in its computer system.

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