Corporate Compliance

OIG: New York schools owe repayment of $96 million in transportation claims

Compliance Monitor, October 12, 2005

Thirteen patient advocacy organizations have released a statement opposing gainsharing on grounds that the cost-saving practice could undermine quality of care.

"Since the latest technology may also be the most expensive, patients may find they have limited options when trying to choose, for example, a new prosthetic most suitable to their needs," explained Andrew Imparato, president & CEO of the American Association of People with Disabilities.

Hospitals enter into gainsharing agreements with physician groups to reward physicians for taking cost-saving

The OIG has determined that the New York City Department of Education (NYCDE) claimed $96 million in prohibited federal Medicaid payments for transportation services. The audit period covered September 1, 1993, through June 30, 2001. None of the 120 transportation claims the OIG audited complied with requirements. Specifically,

  • for 119 claims, the OIG was unable to verify that billed transportation services were rendered

  • for 97 claims, a Medicaid-covered school health service other than transportation was not rendered on days when transportation was billed

  • eight claims lacked documentation altogether

  • for 33 claims, no child's plan/family plan was provided or the plan was untimely

  • 36 claims did not include a recommendation for transportation services in the child's plan/family plan

    The OIG has recommended that the state refund the $96 million and work with CMS to resolve documentation issues for an additional $12 million in claims. To complete the audit, the OIG

  • reviewed applicable federal and state regulations, and prior survey work

  • met with appropriate officials to gain an understanding of procedures for billing transportation services to Medicaid

  • made survey site visits to NYCDE from April 2000 through June 2000

  • identified claims totaling $245 million (with $122 million in federal money) made by NYCDE

  • used stratified random sampling techniques to select a sample of 120 claims from the universe of 1 million transportation claims for review

      Click here to read the audit report, "Review of Medicaid Transportation Claims Made by the New York City Department of Education," (A-02-03-01023) issued Sept. 15, 2005.