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Review of Family Planning Pharmacy Claims Submitted by Selected Providers Under the State of Kansas Medicaid Program

Not all of the family planning pharmacy claims submitted by providers and claimed by the Kansas Health Policy Authority (the State agency) at the enhanced 90-percent Federal financial participation (FFP) rate from July 1, 2005, through June 30, 2009, were allowable pursuant to Federal requirements. Of the 100 claims sampled, 31 claims were not allowable for reimbursement at the enhanced 90-percent FFP rate because the services in question could not be claimed as family planning services pursuant to Federal requirements.

Based on the results of our sample, we estimated that the State agency received $152,000 in unallowable Federal reimbursement. These errors occurred because the Medicaid Management Information Systemís edits did not always correctly identify claims for reimbursement at the enhanced 90-percent FFP rate.

Filed under: Center for Medicare and Medicaid Services