Illegally claiming traumatic brain injury reimbursements allowed the New York State Department of Health to pocket more than $54 million.
According to a report from the Inspector General, New York was able to get reimbursed for $54.3 million in Federal Medicaid money for a services that were part of a traumatic brain injury waiver program that did not follow federal and state requirements. The state's Health Department was able to claim reimbursement for home and community-based services for patients who would otherwise be in a nursing home.
Between January 1, 2007 and December 31, 2009, the Health Department in New York claimed about $196.5 million for the program, $98 million of which was federal money.
The claims made for these services from the program were:
• failing to determine if those assessing individuals for the program were qualified to do so
• failing to determine if the individuals allowed in the program actually qualified for it
• failing to document and bill the proper services
$54,265,195 in Federal Medicaid was reimbursed for completely "unallowable TBI waiver program services" and $662,510 was reimbursed for "potentially unallowable" services.
The Inspector General had three commendations for the Health Department. One recommendation, to begin complying with the three federal and state criteria that weren't followed originally, was accepted by the Health Department. It disagreed with the two recommendations to refund $54 million to the federal government and look into possibly refunding $662,510.