New York’s health department improperly billed Medicaid for more than $23 million through a program dedicated to helping adults with developmental disabilities get and keep jobs they would otherwise be unable to secure.
Between January 2009 and June 2012, the New York health department claimed $171 million for the “supported employment” program, with the federal government picking up the tab for an $86 million share.
A Department of Health and Human Services inspector general’s report found that service providers didn’t track beneficiaries’ eligibility and submitted claims to Medicaid for unallowable services.
Among recommendations to improve compliance with federal and state laws, the government watchdog said New York should return the $23 million in improper payments to Medicaid.
While the supported employment program requires beneficiaries to have a competitive job that pays the minimum wage or more, IG auditors discovered that some beneficiaries earned less money or were not employed at all. Others received their entire salaries from the healthcare providers themselves.
The program requires providers to follow a specified care plan for each beneficiary, which should outline how much assistance an individual needs to perform at work. When care plans were available for review, HHS auditors found state officials had sometimes billed for services at rates higher than the plan allowed or for services that never even appeared on the plan.
Many beneficiaries lacked a care plan or documentation of their employment, progress or services received.
In addition, state health officials sometimes took Medicaid reimbursements from the federal government for services the Education Department was already funding, the report said.
A December 2013 HHS IG report found New Jersey’s health department had improperly billed Medicaid for the majority of its supported employment services.
In addition to many of the same problems facing New York’s program, some of the care and counseling covered under New Jersey’s program was performed by unqualified or untrained providers.
HHS asked New Jersey to pay back nearly $7 million of the $8.5 million the state received in Medicaid reimbursements through the program.
Go here to read the complete HHS IG report.
