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Audit (A-02-10-01002)

04-20-2012
Review of Selected Medicaid Home Health Services Claims Made by Jewish Home and Hospital Lifecare Community Services - Manhattan LTHHCP

Executive Summary

The Department of Health (State agency) did not claim Federal Medicaid reimbursement for some home health services claims submitted by Jewish Home and Hospital Lifecare Community Services - Manhattan LTHHCP (Jewish Home) in accordance with Federal and State requirements. Based on our sample results, we estimate that the State agency improperly claimed $8.2 million in Federal Medicaid reimbursement during our January 1, 2006, through June 30, 2009, audit period.

Of the 100 claims in our random sample, 61 claims complied with Federal and State requirements, but 39 claims did not. Of the 39 claims, 2 contained more than 1 deficiency. Specifically, for 39 claims, the care plan was not reviewed; for 1 claim, there was no documentation that the service was provided; and for 1 claim, the home health aide did not receive basic training.

These deficiencies occurred because (1) Jewish Home and its contracted home health providers did not comply with certain Federal and State requirements and (2) the State agency did not effectively monitor Jewish Home for compliance with certain Federal and State requirements.

For the recession adjustment period (October 1, 2008, through December 31, 2010), the American Recovery and Reinvestment Act of 2009 provided an estimated $87 billion in additional Medicaid funding based on temporary increases in States' Federal medical assistance percentages.

We recommended that the State agency (1) refund $8.2 million to the Federal Government and (2) improve its monitoring of Jewish Home and its contracted home health providers to ensure compliance with Federal and State requirements. Jewish Home disagreed with our findings and recommended financial disallowance, and the State agency disagreed with both of our recommendations.

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