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Brought to you by the Council of the Inspectors General on Integrity and Efficiency
Federal Reports
Report Date
Agency Reviewed / Investigated
Report Title
Type
Location
Department of Health & Human Services
New York State Improperly Claimed Medicaid Reimbursement for Some Adult Day Health Care Services
The New York State Department of Health (State agency) claimed Medicaid reimbursement for some Medicaid adult day health care (ADHC) services 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 60 claims. However, the State agency claimed Medicaid reimbursement for services that were unallowable for the remaining 40 claims. On the basis of our sample results, we estimated that the State agency improperly claimed at least $70 million in Federal Medicaid reimbursement for ADHC services that did not comply with certain Federal and State requirements.
Teaching & Mentoring Communities (TMC) claimed $635,000 in costs that were unallowable under applicable Federal rules and the terms of grants that it was awarded. This amount consisted of $617,000 in health insurance costs that TMC overcharged, $16,000 in unsupported consulting costs and $2,000 in membership costs that did not have prior approval. In addition, TMC did not have adequate controls over its financial management system.
