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Colorado Did Not Always Identify or Prevent Excluded Providers From Participating in the Medicaid Program

The Colorado Department of Health Care Policy and Financing (State agency) did not have adequate internal controls to prevent all Medicaid payments for items and services furnished, ordered, or prescribed by an excluded individual or entity. Although the State agency implemented internal controls to prevent Medicaid payments to excluded individuals or entities, the controls did not address all of the excluded individuals or entities that we identified on Medicaid claims. For the period October 1, 2009, through September 30, 2010, the State agency made $13,000 ($8,000 Federal share) in unallowable payments for items and services furnished, ordered or prescribed by excluded providers.

Filed under: Center for Medicare and Medicaid Services