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Missouri Did Not Always Correctly Claim Costs for Medicaid Family Planning Sterilization Procedures for Calendar Years 2009 and 2010

The Department of Social Services, Missouri HealthNet Division (State agency) did not always correctly claim costs for Medicaid family planning sterilization procedures on its Quarterly Medicaid Statement of Expenditures for the Medical Assistance Program (CMS-64 report) reports for calendar years 2009 and 2010. Specifically, the State agency made two errors on its claims. The State agency claimed costs for Federal reimbursement for the same outpatient hospital or clinic service on two lines of the CMS-64 report. In addition, the State agency used incorrect costs to claim Medicaid family planning sterilization procedures on the CMS-64 reports. As a result of these errors, the State agency overstated the amount of Federal reimbursement reported on the CMS-64 reports by $1,481,000. This excess Federal reimbursement occurred because the State agency's adjustment process-that was designed to identify costs for family planning sterilization procedures-was ineffective.

We recommended that the State agency (1) refund $1,481,000 to the Federal Government, (2) review costs for family planning sterilization procedures for quarterly reporting periods after our audit period and refund any overpayments to the Federal Government, and (3) ensure that future expenditures for family planning sterilization procedures are claimed correctly on the CMS-64 reports. The State agency agreed with our recommendations and described corrective actions that it had implemented or planned to implement, including refunding the $1,481,000. Regarding our second recommendation, the State agency stated that it would refund an additional $893,000 to the Federal Government. We verified that the State agency correctly calculated this overpayment.

Filed under: Center for Medicare and Medicaid Services