Corporate Compliance

GOV’T AUDIT INSIDER: A need to reinforce Medicaid compliance in New York

Healthcare Auditing Weekly, October 5, 2004

The Office of Inspector General (OIG) found that an estimated $17.2 million in Federal Medicaid funding was improperly claimed for transportation services by 695 school and preschool health providers in New York State from September 1, 1993, to June 30, 2001. According to the audit report, the OIG found that 97 of the 110 claims in a statistically valid sample were unallowable, and another group of claims totaling an estimated $35.8 million were set aside for further consideration because of unspecific date documentation. The OIG recommends that New York refund the $17.2 million to the federal government, work with CMS to resolve the set-aside claims, provide Medicaid criteria to schools, reinforce Medicaid compliance in schools, and improve claims monitoring. During the audit, the OIG did the following:

  • Met with CMS regional and central office officials

  • Reviewed federal and state regulations and guidelines

  • Reviewed prior survey work that the OIG performed at 11 schools and preschools in New York

  • Held discussions with New York State Department of Health and State Education Department officials

  • Ran computer programming applications that identified claims from April 1, 1990, to June 30, 2001

  • Eliminated all duplicate claims from another audit report, as well as claims that were reviewed separately

  • Extracted claims from the audit period and used stratified random sampling to select 110 claims

  • Reviewed documentation and followed up with provider officials from the sample schools and preschools

    Click here to read the audit report, "Review of Medicaid Transportation Claims Made by School Health Providers in New York State" (A-02-03-01008), issued August 30.

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