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Review of Additional Claims for Sterilization Procedures in the Colorado Medicaid Family Planning Program

Our review found that the State did not always correctly claim costs for Medicaid family planning sterilization procedures on the CMS-64 reports. For the quarters ended March 2007 through September 2009, the State claimed additional costs for the same sterilization procedures, which resulted in almost $2 million in unallowable Federal reimbursement. Although the State had an informal adjustment process to claim these costs correctly, this process was not effective beginning with the quarter ended March 2007. Federal requirements authorize Medicaid reimbursement at an enhanced 90-percent rate for family planning services, defined as those that prevent or delay pregnancy or otherwise control family size and may also include sterilization procedures.

We recommended that the State (1) refund $2 million to the Federal Government, (2) review costs for family planning sterilization procedures for quarterly reporting periods subsequent to our audit period and refund any overpayments to the Federal Government, and (3) establish written procedures to ensure that future costs for family planning sterilization procedures are claimed correctly on the CMS-64 reports. The State concurred with our recommendations and described corrective actions that it planned to implement.

Filed under: Center for Medicare and Medicaid Services