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Review of Medicaid Personal Care Services Claims Made by Providers in New York City

The State improperly claimed Federal Medicaid reimbursement for some personal care services claims submitted by providers in New York City from January 1, 2004, through December 31, 2006. Of the 100 claims in our random sample, 80 claims complied with Federal and State requirements, but 18 claims did not. We could not determine whether the remaining two claims, which involved services under the State's Consumer Directed Personal Assistance Program (CDPAP), complied with Federal and State requirements. Based on our sample results, we estimate that the State improperly claimed $275.3 million in Federal Medicaid reimbursement during the audit period.

This overpayment occurred because the State did not adequately monitor New York City's personal care services program for compliance with certain Federal and State requirements.

We recommended that the State (1) refund $275.3 million to the Federal Government, (2) work with CMS to resolve the two CDPAP claims, (3) improve its monitoring of New York City's personal care services program to ensure compliance with Federal and State requirements, and (4) promulgate specific regulations related to claims submitted under the CDPAP. In its comments on our draft report, the State disagreed with our first recommendation and agreed with our remaining recommendations. The State also disagreed with many elements of our findings.

Filed under: Centers for Medicare and Medicaid Services