Of the $18.2 million in hysterectomy expenditures that the Oklahoma Health Care Authority (State agency) claimed from January 1, 2005, through December 31, 2009, it improperly claimed $17.4 million at the enhanced family planning Federal Medical Assistance Percentage (FMAP) of 90 percent. As a result, the State agency inappropriately received an additional $3.4 million (Federal share).
The Federal Government pays its share of a State's medical assistance expenditures under Medicaid based on the FMAP, which varies depending on the State's relative per capita income. The FMAP for family planning expenditures is 90 percent, which is higher than the regular FMAP. The Federal Government pays its share of hysterectomy expenditures at the regular FMAP.
We recommended that the State agency (1) refund to the Federal Government the $3.4 million in overpayments that it received for hysterectomy expenditures claimed at the enhanced family planning FMAP, (2) refund to the Federal Government any overpayments that it may have received for hysterectomy expenditures claimed at the enhanced family planning FMAP in quarters after our audit period, and (3) discontinue claiming hysterectomy expenditures at the enhanced family planning FMAP. The State agency agreed with our finding and stated that it had removed all hysterectomy billing codes from the list of family planning codes in its computer system.
Dallas L Alford IV, CPA is a licensed Certified Public Accountant in the state of North Carolina and owner of Atlantic Financial Consulting, a consulting firm that provides comprehensive medical billing services, practice management consulting, coding audits, Medicare compliance, Medicare RAC support and other general medical practice consulting services.
To learn more about Atlantic Financial Consulting you may visit their website at
http://atlanticfinancial.us or contact Dallas L Alford IV, CPA directly at 1 888-428-2555, Ext. 200.
The Federal Government pays its share of a State's medical assistance expenditures under Medicaid based on the FMAP, which varies depending on the State's relative per capita income. The FMAP for family planning expenditures is 90 percent, which is higher than the regular FMAP. The Federal Government pays its share of hysterectomy expenditures at the regular FMAP.
We recommended that the State agency (1) refund to the Federal Government the $3.4 million in overpayments that it received for hysterectomy expenditures claimed at the enhanced family planning FMAP, (2) refund to the Federal Government any overpayments that it may have received for hysterectomy expenditures claimed at the enhanced family planning FMAP in quarters after our audit period, and (3) discontinue claiming hysterectomy expenditures at the enhanced family planning FMAP. The State agency agreed with our finding and stated that it had removed all hysterectomy billing codes from the list of family planning codes in its computer system.
Dallas L Alford IV, CPA is a licensed Certified Public Accountant in the state of North Carolina and owner of Atlantic Financial Consulting, a consulting firm that provides comprehensive medical billing services, practice management consulting, coding audits, Medicare compliance, Medicare RAC support and other general medical practice consulting services.
To learn more about Atlantic Financial Consulting you may visit their website at
http://atlanticfinancial.us or contact Dallas L Alford IV, CPA directly at 1 888-428-2555, Ext. 200.
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