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New York Improved Its Monitoring of Medicaid Community Rehabilitation Services But Still Claimed Improper Federal Medicaid Reimbursement Totaling $20 Million

Submitting OIG: 
Department of Health & Human Services OIG
Date Issued: 
Monday, July 31, 2023
Agency Reviewed / Investigated: 
Department of Health & Human Services
Submitting OIG-Specific Report Number: 
A-02-22-01011
Component, if applicable: 
Centers for Medicare & Medicaid Services
Centers for Medicare and Medicaid Services
External entity, if applicable: 
New York State Department of Health
Location(s): 
NY,
United States
Type of Report: 
Audit
Questioned Costs: 
$19,888,031
Funds for Better Use: 
$0
Number of Recommendations: 
2
Report updated under NDAA 5274: 
No

Related Open Recommendations

Recommendation Number Recommendation Status Significant Recommendation Additional Details
23-A-02-093.01 Open No
We recommend that New York State Department of Health refund $19,888,031 to the Federal Government.
23-A-02-093.02 Open No
We recommend that the New York State Department of Health work with the New York State Office of Mental Health to improve monitoring activities by increasing the number of case files reviewed when conducting provider site visits to ensure that service plans and subsequent service plan reviews are timely signed and maintained, community rehabilitation claims meet Medicaid reimbursement standards, and services are appropriately authorized. We recommend that the New York State Department of Health work with the New York State Office of Mental Health to improve monitoring activities by providing formal guidance or training to providers to clarify requirements related to service plans and subsequent service plan reviews being timely signed and maintained, community rehabilitation claims meeting Medicaid reimbursement standards, and services being appropriately authorized.
Displaying 2 of 2 Recommendations