The Health and Human Services inspector general has determined that New York misspent millions of dollars in incorrect billing for Medicaid, since no one decided to pay any attention to beneficiary eligibility.
In fact, the New York Health Department didn’t even track eligibility, and further submitted claims for services not allowed under current regulations– all without batting an eye.
“Some of the Health Department’s claims for Federal Medicaid reimbursement for supported employment services did not comply with certain federal and state requirements… the Health Department claimed Medicaid reimbursement for unallowable supported employment services during the remaining 35 beneficiary-months,” the report notes.
According to the rules, beneficiaries are supposed to be employed in jobs paying at least the minimum wage and higher above the minimum wage. The inspector general found the exact opposite: Some beneficiaries made less than the requirement amount, others weren’t even employed at all, or received their salary from health care providers who submitted their Medicaid claims.
Billing for services came under similar scrutiny. Services were billed higher than plans allowed for, and in some cases, the services weren’t even allowed under the plans. Amazingly, some beneficiaries still submitted claims even without plans.
The inspector general also identified a costly redundancy, where claims were submitted for services the Education Department was already funding.
The watchdog has encouraged New York to return the $23,054,993 million dollars of Medicaid reimbursements it owes back to the federal government, and second, to more carefully follow federal and state regulations for health care providers next time.
But the Health Department disagreed, arguing that 14 out of the 38 items highlighted by the inspector general were incorrect. After much revisiting of the paperwork, the inspector general concluded definitively that 10 of those 14 items were still valid problems.
The inspector general’s review was limited to supported employment services, examining the period between Jan. 1, 2009 and June 30, 2012.
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