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Review of Prescribed Drug Costs in the Colorado Medicaid Family Planning Program

The Colorado Department of Health Care Policy and Financing (the State agency) did not always claim family planning prescribed drug costs during fiscal years 2006 through 2009 pursuant to Federal and State requirements. Of the 100 claims in our sample, 73 qualified as family planning services and were allowable for Federal reimbursement at the enhanced 90-percent rate (90-percent rate). The 27 remaining claims in our sample totaling $1,100 (Federal share) contained errors. Specifically, 26 of the claims were not allowable for Federal reimbursement at the 90-percent rate (but were allowable for Federal reimbursement at lower Federal medical assistance percentage rates) because the contraceptive drugs in question were not prescribed for family planning purposes. The other claim was not allowable for any Federal reimbursement pursuant to Federal and State requirements because it lacked supporting documentation. Based on the results of our sample, we estimated that the State agency received $618,000 in unallowable Federal reimbursement.

Filed under: Center for Medicare and Medicaid Services