State Over Billed The Feds for Family Planning

The state refunds the federal government $1.7 million with another $3 million under review

February 22, 2011 -- A federal audit recently found the Oregon Health Authority improperly claimed $1.7 million in federal reimbursement for a program that offers family planning services to low-income Oregonians

A routine audit by the Office of Inspector General for the Department of Health and Human Services found the state had not properly verified the income or social security numbers of enrollees to an expanded Medicaid program known as Oregon Contraceptive Care also called the Family Planning Expansion Project

The audit found the lack of income and social security verification along with duplicate billing amounted to $1.7 million in improperly federal reimbursement with another $3 million in questionable reimbursement yet to be reviewed.

The federal government has demanded a refund of the $1.7 million while it conducts a further review of the $3 million, based on a recent press release. None of the errors, however, resulted in any fraud charges.

The program in question has offered contraceptives and other family planning services since 2006 to individuals who earn up to 185 percent of the federal poverty level but would not otherwise qualify for Medicaid. Serving 100,000 recipients, the program has an annual budget of $64 million, including about $57 million coming from federal matching funds.

While the program does not pay for abortions, it does fund comprehensive sexual and reproductive health services including birth control and counseling. Funding also goes toward cancer screening, infertility prevention, pregnancy tests and treatment for sexually transmitted diseases. In addition, the program collects data on community health needs and advises clinics and other providers.

Clients enroll at the clinic level based on their income qualifications and valid social security number, but it’s up to the Oregon Health Authority to verify the applications as well as the claims for billing by the various clinics that serve clients, said Alissa Robbins, spokesperson for OHA.

Robbins said the errors were corrected as soon as they were identified and that the agency was able to adjust its budget so as not to affect client services. The audit helped reveal a weakness in the state’s review processes, and it will actually strengthen the program, she said.

“The program had been verifying social security numbers for 100 percent of clients and verifying the income of a statistically significant number of clients,” Robbins said. “Through the audit, the program learned there needed to be 100 percent client income verification as well.”

The audit also revealed the duplicate submission of claims at the clinic level, which Robbins described as errors in electronic billing.

“At the state level, new processes will allow close monitoring and correction of these errors,” Robbins said. “Now, if a clinic mistakenly makes a billing error, the program can catch it quickly and follow up with the clinic to ensure it gets corrected.”

Along with strengthening the qualification procedure and claims processes, the state has submitted a plan to the Centers for Medicare & Medicaid Services on how it will address income verification going forward.

As part of its audit, OIG investigators reviewed 401,486 claims totaling $56.4 million in federal funds and another sample of 46,550 claims totaling $6.3 million, according to a recent press release.

It was from the $6.3 million the audit found the state had not verified the family incomes and social security numbers for claims totaling about $3 million.

“Because the supporting documentation was not readily available for these claims, we have set aside this amount for resolution by the Centers for Medicare & Medicaid Services and the state agency,” the release states.

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