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Missouri Incorrectly Claimed Federal Reimbursement for Inpatient Claims With Sterilization and Delivery Procedures for Calendar Years 2009 and 2010

03-13-2013 | Audit (A-07-12-01121) | Complete Report

The Department of Social Services, Missouri HealthNet Division (State agency) incorrectly claimed costs for family planning sterilization and delivery procedures during calendar years (CY) 2009 and 2010. None of the 2,919 inpatient claims with sterilization and delivery procedures that the State agency claimed as family planning services qualified for Federal reimbursement at the enhanced 90-percent rate (but they were allowable at the Federal medical assistance percentage, which ranged from 71.24 percent to 74.43 percent for claims paid during CYs 2009 and 2010) because the State agency did not distinguish between the costs for family planning services and those for non-family-planning services. The difference between the amounts associated with these 2 rates was $862,000, which represents excess Federal reimbursement for the 2,919 family planning inpatient claims.

Filed under: Center for Medicare and Medicaid Services