Federal Reports

Some of the New York State Department of Health's (State agency) claims for Federal Medicaid reimbursement for Long-Term Home Health Care Waiver Program (LTHHCP) services did not comply with certain Federal and State requirements. On the basis of our sample results, we estimated that the State agency improperly claimed at least $2.6 million in Federal Medicaid reimbursement for unallowable LTHHCP services.

Medicare contractor payments made to providers in Jurisdiction H (Arkansas, Colorado, Louisiana, Mississippi, New Mexico, Oklahoma, and Texas) for hospital outpatient dental services generally did not comply with Medicare requirements. Of the 100 dental services in our stratified random sample, 91 did not comply with Medicare requirements. Using our sample results, we estimated that Medicare contractors improperly paid providers in Jurisdiction H at least $1.7 million from January 1, 2012, through August 31, 2014.

DePaul Health Center (the Hospital) (operating in Bridgeton, Missouri) complied with Medicare billing requirements for 190 of the 204 inpatient and outpatient claims we reviewed. However, the Hospital did not fully comply with Medicare billing requirements for the remaining 14 claims (all of which were inpatient claims), resulting in overpayments of $81,000 for calendar years 2012 and 2013. These errors occurred primarily because the Hospital did not have adequate controls to prevent the incorrect billing of Medicare claims within the selected risk areas that contained errors.