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Review of Medicaid Claims Submitted by Continuing Day Treatment Providers in New York State

The New York State Department of Health (DOH) did not claim Federal Medicaid reimbursement for continuing day treatment (CDT) services provided by nonhospital providers in the State in accordance with State requirements. Based on our sample results, we estimate that DOH improperly claimed $84.4 million in Federal Medicaid reimbursement during our January 1, 2005, through December 31, 2008, audit period. Of the 100 claims in our random sample, all claims complied with Federal requirements and 43 claims complied with Federal and State requirements, but 57 claims did not comply with State requirements. Of the 57 noncompliant claims, 10 contained more than 1 deficiency.

The CDT program provides active treatment to Medicaid recipients designed to maintain or enhance current levels of functioning and skills, to maintain community living, and to develop self-awareness and self-esteem through the exploration and development of strengths and interests.

We recommended that DOH (1) refund $84.4 million to the Federal Government, (2) work with the State Office of Mental Health (OMH) to issue guidance to the provider community regarding State requirements for claiming Medicaid reimbursement for CDT services, and (3) work with OMH to improve OMH's monitoring of the CDT program to ensure compliance with State requirements. DOH disagreed with our first recommendation and did not indicate concurrence or nonconcurrence with our remaining recommendations.

Filed under: Centers for Medicare and Medicaid Services