New York State Improperly Claimed Medicaid Reimbursement for Continuous 24-Hour Personal Care Claims in Ulster County

The New York Department of Health's (State agency) claims for Federal Medicaid reimbursement for high-dollar continuous 24 hour personal care services provided to beneficiaries in Ulster County, totaling $6.3 million, did not comply with Federal and State requirements. This occurred because (1) the local social services district (the district) did not comply with requirements for assessing and approving continuous 24-hour personal care services and (2) the State agency did not adequately monitor the district's administration of the Ulster County personal care services program. High-dollar claims included services for beneficiaries with total Medicaid paid amounts greater than $10,000.

We recommended that the State agency (1) refund $6.3 million to the Federal Government and (2) improve its monitoring of the district to ensure the district's compliance with Federal and State requirements related to continuous 24-hour personal care services. The State agency did not indicate concurrence or nonconcurrence with our first recommendation (financial disallowance) and generally agreed with our second recommendation.