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Wyoming Incorrectly Claimed Enhanced Reimbursement for Medicaid Family Planning Sterilization Costs

The Wyoming Department of Health (State agency) did not always claim costs for Medicaid family planning inpatient sterilization procedures for calendar years 2006 through 2010 pursuant to Federal and State requirements. The State agency claimed 308 of the 1,638 family planning sterilization procedure claims using the correct rates of Federal reimbursement. However, the remaining 1,330 claims (4 claims contained multiple errors) were claimed at incorrect rates of Federal reimbursement or were unallowable, resulting in unallowable Federal reimbursement totaling $1.3 million. These errors occurred because the State agency's controls were not adequate to ensure that it claimed costs pursuant to Federal and State requirements over the course of the audit period.

We recommended that the State agency (1) refund the $1.3 million to the Federal Government, (2) review costs for inpatient sterilization procedures for quarterly reporting periods after our audit period and refund any overpayments, and (3) strengthen internal controls to ensure that costs for Medicaid family planning sterilization procedures are claimed pursuant to Federal and State requirements. The State agency concurred with all of our recommendations.

Filed under: Center for Medicare and Medicaid Services