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Review of Medicaid Family Planning Services Claimed Under the Oregon Health Plan During the Period October 1, 2006, Through September 30, 2009

Our review found that Oregon was overpaid $1.5 million (Federal share) for Medicaid services that were not related to family planning during the period October 1, 2006, through September 30, 2009. Medicaid reimburses family planning services at the enhanced Federal medical assistance percentage (FMAP) of 90 percent (90-percent rate). Family planning services prevent or delay pregnancy or otherwise control family size.

Contrary to State requirements, the claims did not contain appropriate diagnosis codes related to contraceptive management and thus were ineligible for reimbursement at the 90-percent rate. However, these claims were eligible for reimbursement at Oregon's regular FMAP for the years in which the claims were paid. The overpayment occurred because the State agency's Medicaid Management Information System (MMIS) controls did not properly distinguish claims eligible for reimbursement at the 90-percent rate from claims eligible for reimbursement at the regular FMAP rate. In December 2008, the State agency implemented a new MMIS and changed its internal controls to properly identify these claims.

We recommended that Oregon (1) refund $1.5 million to the Federal Government and (2) identify and refund any overpayments for family planning claims before October 1, 2006, that did not contain appropriate diagnosis codes identifying the claims as eligible for reimbursement at the 90-percent rate. Oregon concurred with our recommendations. /p>

Filed under: Center for Medicare and Medicaid Services