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New York Claimed Federal Reimbursement for Some Assertive Community Treatment Services That Did Not Meet Medicaid Requirements

New York claimed Federal Medicaid reimbursement for some Assertive Community Treatment (ACT) services that did not comply with Medicaid requirements. Specifically, of the 100 claims in our random sample, 87 claims complied with Medicaid requirements, but 13 claims did not.

Providers did not always ensure that ACT services were provided in accordance with a beneficiary’s treatment plan and did not always verify that the required number of contacts needed to claim the ACT full payment rate was provided. Further, certain providers failed to maintain or provide documentation to support ACT services claims. Finally, although New York monitors ACT providers for compliance with Medicaid requirements, it did not ensure that its oversight was effective in preventing the errors identified in our review. We recommended that New York (1) refund $4.4 million to the Federal Government, (2) ensure that ACT program guidance on claiming Medicaid reimbursement for services is reinforced with providers, and (3) continue to improve its monitoring of the ACT program.

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Office of Inspector General, U.S. Department of Health and Human Services | 330 Independence Avenue, SW, Washington, DC 20201