New York DOH claimed $21 million in overpayments for IMD services
Healthcare Auditing Weekly, July 22, 2008
The New York State Department of Health (DOH) improperly claimed over $21 million in Federal Medicaid Reimbursement during a five-year period, according to a report from the OIG.
The DOH claimed $21,531,996 for services provided by 11 freestanding alcohol and substance abuse residential treatment facilities from April 1, 2001 to March 31, 2006. The facilities are considered by Medicaid to be Institutions for Mental Diseases (IMDs).
The overpayments occurred because:
- The DOH incorrectly coded claims from nine IMDs as eligible for reimbursement, using the Medicaid Management Information System (MMIS) – a computerized payment and information reporting system for processing claims and payments.
- One provider (NRI Group) billed Medicaid for inpatient rehabilitation services using an outpatient category-of-service code.
- The DOH claimed reimbursement for services by one provider (Can Am Youth Services) that did not fit the definition of an IMD.
The DOH indicated it credited the Federal Government $14,949,737 in overpayments, but did not provide documentation to the OIG of this credit.
The OIG is recommending that the DOH:
- Refund the balance of the $21,531,996 overpayment to the Federal Government
- Ensure the MMIS is working properly so claims are coded correctly
- Designate NRI Group LLC claims for inpatient rehabilitation services as federally nonparticipating in its MMIS for beneficiaries under 65 years of age
- Designate Can Am Youth Services as federally nonparticipating in its MMIS for beneficiaries under 65 years of age
- Determine the amount of improper reimbursement claimed prior to the OIG’s audit and return those overpayments to the Federal Government
The DOH generally agreed with the OIG’s recommendations. After the audit, the OIG was able to obtain documentation that the DOH has already refunded $14,949,737 to the government, bringing the balance to $6,582,259.
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