Colorado Improperly Claimed Some Medicaid Costs for Hospice Services Provided by Evercare Hospice & Palliative Care

The Colorado Department of Healthcare Policy & Financing (State agency) did not always claim costs for hospice services provided by Evercare Hospice & Palliative Care (Evercare) in accordance with Federal and State requirements. Based on the results of our statistical sample, we estimated that the State agency incorrectly reimbursed Evercare at least $124,000 ($75,000 Federal share) for the period October 1, 2009, through September 30, 2011, and incorrectly claimed these costs for Federal reimbursement. The net overpayments occurred because the State agency's claims processing system did not have adequate computer edits and other internal controls to always ensure that the State agency correctly claimed costs for hospice services provided under the Medicaid program.