Fee-For-Service Family Planning Claimed by Colorado

EXECUTIVE SUMMARY:

Our objective was to determine if Colorado claimed Medicaid fee-for-service family planning costs for FY 1999 in accordance with Federal laws and regulations.  We found that Colorado did not claim these costs in accordance with Federal laws and regulations.  Colorado claimed $1,153,986 that did not qualify as family planning costs, which caused $454,786 in excessive Federal Medicaid reimbursement.  Colorado treated negative adjustments as paid claims and classified nonfamily planning claims as family planning because its computer programs did not ensure that negative adjustment amounts were subtracted instead of added or that nonfamily planning costs were extracted from all inpatient claims.  We recommend that Colorado:  (1)  refund $454,786 to the Federal Government, (2) ensure claims for family planning are based on accurate and reliable information, and (3) review the $12.1 million in Federal reimbursement received for family planning services under fee-for-service for FY 2000 to December 2003 for errors and refund unallowable costs.  Colorado agreed with our findings and recommendations.