New York Claimed Medicaid Reimbursement for Some Adult Day Health Care Services Provided by Metropolitan Jewish Health System That Were Unallowable

The New York State Department of Health (State agency) claimed Medicaid reimbursement for some adult day health care services (ADHC) provided by Metropolitan Jewish Health System (MJHS) that did not comply with certain Federal and State requirements. Of the 100 claims in our random sample, the State agency properly claimed Medicaid reimbursement for 80 claims. Of the remaining claims, 18 contained services that did not comply with Federal and State requirements, and, for 2 others, we could not determine whether the associated services complied with Federal and State requirements. We estimated that the State agency improperly claimed at least $1.1 million in Federal Medicaid reimbursement for ADHC services provided by MJHS that that did not comply with certain Federal and State requirements.