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