New York Claimed Some Unallowable Costs for Assistive Technology Services Under the State's Developmental Disabilities Waiver Program
The New York State Department of Health (State agency) claimed Federal Medicaid reimbursement for some assistive technology services that did not comply with certain Federal and State requirements. On the basis of our sample results, we estimated that the State agency improperly claimed at least $1.8 million in Federal Medicaid reimbursement for assistive technology services that were unallowable. In addition, the State agency claimed $10,000 in Federal Medicaid reimbursement for a portion of five payments for assistive technology services that may not have complied with Federal and State requirements.
Of the 137 payments in our random sample, the State agency properly claimed Medicaid reimbursement for 93 payments. However, for the remaining 44 payments, the State agency claimed Medicaid reimbursement for services that were unallowable or potentially unallowable. Specifically, 39 payments were for services that did not comply with certain Federal and State requirements, and for 5 payments, we could not determine whether the services complied with Federal and State requirements. Of the 39 payments for which the State agency improperly claimed Federal reimbursement, 2 payments contained more than 1 deficiency.
The claims for unallowable and potentially unallowable services were made because the State agency's and the Office for People with Developmental Disabilities' (OPWDD) policies and procedures for overseeing and administering payments for assistive technology services did not adequately ensure that (1) services were provided only in accordance with written plans of care and (2) contractors properly claimed reimbursement for covered services and for services actually provided, maintained required documentation to support services billed, and properly allocated costs to the waiver program.
We recommended that the State agency (1) refund $1.8 million to the Federal Government;
(2) work with CMS to resolve the portion of the five payments, totaling $10,000, for which the State agency may have claimed unallowable Federal Medicaid reimbursement and, if applicable, refund any unallowable amounts; and (3) work with OPWDD to strengthen the agencies' policies and procedures. The State agency agreed with our findings and recommendations.
Filed under: Centers for Medicare and Medicaid Services