Review of Federal Medicaid Claims Made for Beneficiaries in the Family Planning Benefit Program in New York State

New York State improperly received Federal reimbursement for claims made on behalf of beneficiaries enrolled in a State program that expands Medicaid eligibility to low-income individuals.  The Family Planning Benefit Program (FPBP) provides only Medicaid-reimbursed family planning services, exclusive of abortions, for individuals with incomes at or below 200 percent of the Federal poverty level. 

Of the 147 FPBP claims in our sample, 37 were not eligible for Federal Medicaid reimbursement.  This occurred because:  (1) prior to May 2003, the State's computerized Medicaid payment system did not adequately identify FPBP claims that were not related to family planning; (2) some providers incorrectly claimed services as family planning; and (3) some providers did not properly complete a sterilization consent form.  As a result, the State improperly received nearly $1 million in Federal Medicaid funds.

We recommended that the State refund the overpayment, reemphasize to providers that only family planning services may be billed to Medicaid for FPBP beneficiaries, and reinforce guidance regarding sterilization consent forms. The State generally concurred with our recommendations but indicated that it would like to review our working papers prior to refunding improper Federal Medicaid funds.