Federal Reports

The New York State Department of Health claimed Federal Medicaid reimbursement for dental services billed by a New York City dentist that did not comply with certain Federal and State requirements. Of the 100 randomly selected claims that we reviewed, 88 claims complied with Federal and State requirements. However, for the remaining 12 claims, the dentist who performed the services was not enrolled in the Medicaid program because their Medicaid enrollment status was not verified prior to the services being provided. On the basis of our sample results, we estimated that the State agency claimed at least $64,400 in Federal reimbursement for unallowable dental services billed by the New York City dentist.

Semiannual Report

The North Dakota Department of Human Services' (State agency) claims for Medicaid reimbursement for Targeted Case Management (TCM) services provided and paid for during Federal fiscal years (FYs) 2013 and 2014 were not always in accordance with Federal requirements. Specifically, the State agency claimed at least $349,000 (Federal share) of unallowable Medicaid reimbursement and an estimated $862,000 (Federal share) of potentially unallowable Medicaid reimbursement for TCM services during this period. These errors occurred because the State agency did not have adequate policies and procedures in place to ensure that the TCM services it claimed were allowable for Medicaid reimbursement in accordance with Federal requirements.