Review of Family Planning Service Costs Claimed by Maryland's Medicaid Managed Care Program

EXECUTIVE SUMMARY:

Our objective was to determine whether Maryland claimed family planning service costs under its Medicaid managed care program in accordance with its methodology and Federal statutes, regulations and guidelines. Maryland did not claim family planning service costs in accordance with its methodology.  Maryland included ineligible costs in its family planning factor calculation.  As a result, between July 2000 and March 2004, Maryland overstated its claims of family planning service costs by $2.9 million.  By claiming these costs at the enhanced family planning rate of 90 percent, rather than its regular Federal share of 50 percent, Maryland received $228,643 in unallowable Federal reimbursement.  We recommended that Maryland refund the Federal share of $228,643, and apply the audited family planning factor of 1.33 percent for claims after March 2004 and refund the Federal share of any overpayment.  Maryland concurred with our recommendations.