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Review of Clinic and Practitioner Claims Billed as Family Planning Services Under the New York State Medicaid Program

机译：根据纽约州医疗补助计划审查被列为计划生育服务的诊所和从业者索赔

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Attached is an advance copy of our final report on our review of clinic and practitioner claims ofour billed as family planing services under the New York State (the State) Medicaid program. We planning services under the New York wil issue this report to New York State within 5 business days. will issue this report to New York State within 5 Our objective was to determine whether the State properly claimed enhanced 90-percent Federal reimbursement for family plannng claims submitted by clinics and practitioners. planning claims submitted by clinics and The State improperly received enhanced 90-percent Federal reimbursement for family planng received enhanced 90-percent Federal reimbursement for family planning claims submitted by clinics and practitioners. Of the 119 claims in our sample, 17 qualified as Of the 119 claims 17 family plannng services. However, the remaining 102 did not. Of those 102 claims, 96 were for planning services. However, the remaining 102 Ofthose 102 claims, 96 services unelated to family planing, 2 did not include a properly completed sterilization unrelated to family planning, 2 did not include a properly completed was not provided. Based consent form, 3 lacked documentation, and 1 was for a service that was not provided. Based on received $ our sample results, we estimated that the State improperly received $17,151,156 in Federal Medicaid reimbursement. occured because This overpayment occurred because providers incorrectly claimed services as family planning, and the State's Medicaid Management Information System (MMIS) edit routines did not Medicaid Management Information System (MMIS) edit routines did not identify claims unrelated to family planning. adequately identify claims unelated to family planing.

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