Review of Medicaid Obstetrical Maternal Services Claims Billed as Family Planning Under the New York State Medicaid Program

EXECUTIVE SUMMARY:

This audit is one of a series of reports on Medicaid family planning claims made by States.  Our objective was to determine whether the Medicaid Obstetrical Maternal Services for which New York received Federal reimbursement at the enhanced 90-percent rate qualified as family planning services.  We determined that the services did not qualify as family planning services.

We recommended that the State: (1) refund $1,566,740 to the Federal Government, (2) instruct Medicaid Obstetrical Maternal Services providers not to preset the family planning indicator field to 'Yes' in their Medicaid claims software, (3) issue clear guidance to Medicaid Obstetrical Maternal Services providers that any procedures provided to pregnant women may not be claimed as family planning services, (4) strengthen Medicare Management Information System edit routines to make use of all appropriate information on the Medicaid Obstetrical Maternal Services claims to properly identify those that are not related to family planning, and (5) determine the amount of Federal funds improperly reimbursed at the 90-percent rate for Medicaid payments to Medicaid Obstetrical Maternal Services providers for non-family-planning services after our January 1, 2000, through December 31, 2003, audit period and refund that amount to the Federal Government.  The State concurred with our first and last recommendation and indicated it would take specific actions to address the remaining recommendations.