OIG finds DOH should refund nearly $8 million to federal government

In a recent audit of the New York State Department of Health (DOH), the Office of the Inspector General of the United States Department of Health and Human Services (OIG) found that several New York City area providers billed Medicaid for services that did not meet state and federal requirements.  OIG recommended that DOH refund nearly $7.8 million to the federal government and that the both DOH and the New York State Office for People with Developmental Disabilities (OPWDD) alter its policies and procedures.

The services in question are part of a waiver for Medicaid home and community-based services (HCBS).  The program is designed  to help New Yorkers with disabilities live in community settings.  OPWDD provides services for and administers the waiver program, while DOH handles the program’s Medicaid reimbursement.

OIG found that DOH and OPWDD procedures did not ensure that providers claimed reimbursement for services actually provided, and that providers did not maintain documentation concerning the services billed or provide services as part of a written plan of care for recipients.

DOH and OPWDD concurred with OIG’s recommendation that DOH refund the nearly $8 million to the federal government.  Furthermore, DOH and OPWDD have agreed to revise their procedures to address the concerns expressed in the OIG audit.

OIG’s press release may be found here:  http://oig.hhs.gov/oas/reports/region2/21001027.asp

OIG’s report may be found here: http://oig.hhs.gov/oas/reports/region2/21001027.pdf

Caitlin Monjeau

About Caitlin Monjeau

Caitlin is an associate with our Health Law department in the Albany office. She is a magna cum laude graduate of Boston University School of Law where she served as Articles Editor for the Boston University Law Review, and is a graduate of Duke University with a major in English and minor in Political Science. Caitlin was an intern with the United States Attorney’s Office, Criminal Division in Boston, MA before joining O’Connell and Aronowitz. Her experience includes clerkships with the Office of the General Counsel at Boston University and New York State Supreme Court, Appellate Division, 3rd Department. She also interned with the Office of Senator Hillary Rodham Clinton. While in law school, Caitlin was honored with the Paul J. Liacos Scholar and G. Joseph Tauro Distinguished Scholar awards. She also received the Best Oralist award in the Stone Moot Court Competition in 2009, and she was the Winner and recipient of the Best Brief Award for the Sutherland Cup Moot Court Competition in 2011.