North Carolina Incorrectly Claimed Enhanced Federal Reimbursement for Some Medicaid Services That Were Not Family Planning.

摘要

Pursuant to section 1903(a)(5) of the Act and Federal regulations (42 CFR S 433.10(c)(1)), the amount the Federal Government is authorized to reimburse the State for expenditures in family planning services is calculated at an FMAP of 90 percent (enhanced rate). North Carolinas Administrative Code (10A NCAC S 13J.1402(a)(2)(C)) requires that providers adequately document services. From October 1, 2004, through September 30, 2007, the Federal Government reimbursed the State agency at the enhanced rate $52,305,271 (Federal share) for Medicaid family planning services for pharmacy, sterilization, and clinic and practitioner claims. Our objective was to determine whether the State agency claimed Medicaid family planning reimbursement in accordance with Federal and State requirements.