Follow-up Audit of the Health Care Financing Administration's Resolution of Two Office of Inspector General Audits Related to Inpatient Alcoholism Claims Made by New York State

EXECUTIVE SUMMARY:

In two previous reports we had recommended that New York (1) refund approximately $3.9 million for improper alcoholism claims not covered under Medicaid, (2) cease claiming for such services, (3) develop edits and controls to prevent improper claiming, and (4) identify and return unallowable amounts claimed subsequent to the periods audited. Our follow-up audit showed that the Health Care Financing Administration (HCFA) properly addressed the first three recommendations. With regard to the fourth recommendation, HCFA accepted a refund for $654,982 from the State without performing any validation work regarding the reasonable of this amount. Our validation work showed the refund amount should have been $6,347,061, a difference of $5,692,079. We recommended that HCFA seek recovery of this additional amount. The HCFA concurred.