Review of Medical Assistance Claims for State Operated Psychiatric Center Clients Between The Ages of 21 to 64 Who Were Temporarily Released To Acute Care Facilities for Medical Treatment

EXECUTIVE SUMMARY:

This final audit report points out that New York has and is continuing to improperly claim Federal sharing for clients between the ages of 21 to 64 who are temporarily released from State operated institutions for mental diseases (IMDs) to acute care hospitals for medical treatment. In clarifying guidance, the Health Care Financing Administration (HCFA) has made it clear that during a temporary release to an acute care facility for medical treatment, the clients retain their IMD status and, as such, FFP claims for the medical treatment are not allowable. Improper claims could total as much as $9.2 million (FFP) for the 3-year period ending December 31, 1993. In addition to financial adjustments, we recommended that the State cease claiming FFP for such services. The State disagreed. The HCFA, however, totally concurred with our findings and recommendations.