Some of the New York State Department of Health’s (Health Department) claims for Federal Medicaid reimbursement for supported employment services did not comply with certain Federal and State requirements. On the basis of our sample results, we estimated that the Health Department improperly claimed at least $23 million in Federal Medicaid reimbursement for unallowable supported employment services. Specifically, the Health Department accurately claimed Medicaid reimbursement for all supported employment services during 65 of the 100 beneficiary-months in our random sample. However, the Health Department claimed Medicaid reimbursement for unallowable supported employment services during the remaining 35 beneficiary-months. Supported employment services are vocational services for individuals with developmental disabilities.
The Health Department made claims for unallowable services because providers did not ensure (1) that services claimed were properly billed as supported employment services, (2) that supported employment services were provided only to beneficiaries with completed and approved care and supported employment plans, (3) that supported employment services were adequately documented, (4) that supported employment services were claimed at the appropriate level-of-support billing rate, (5) that beneficiaries’ assessments and level-of-care evaluations were documented, and (6) that beneficiaries were not eligible for similar services through the Education Department.
We recommended that the Health Department (1) refund $23 million to the Federal Government and (2) ensure that it complies with certain Federal and State requirements. The Health Department partially agreed with our recommendations and described actions it planned to take to address our findings and recommendations.