Irvington Developmental Disability Provider Overcharged Medicaid by $250K

An audit of the Medicaid program at a Westchester outpatient developmental disability service provide found that they overcharged taxpayers more than $254,000.  The service provider, Abbott House, located in Irvington, NY, will now be required to repay the amount to the state Medicaid program. The overpayments were found during an audit by the New York State Office of the Medicaid Inspector General (OMIG).

Outpatient services provided to persons with developmental disabilities are offered at programs licensed by the Office for People with Developmental Disabilities (OPWDD). The purpose of these programs is to offer a comprehensive system of services, with the goal of promoting and attaining independence, inclusion, and productivity for persons with mental retardation and developmental disabilities. These services are furnished at clinic and day treatment facilities and through home- and community-based federal waiver programs.  Abbott House is one of the providers of these services.

The audit found missing information in Medicaid consumer records needed to support reimbursement for service.  Auditors found that critical components of consumer records were absent, so they could not confirm whether a consumer had responded to treatment. Additionally, Abbott House billed for more days of service than were documented, as well as for services when there was not a required residential habilitation plan. 

“The fact that there was no record of these services being provided raises concerns about Medicaid consumer safety and progress,” said Medicaid Inspector General James C. Cox, “taxpayers should not pay for undocumented services.”

OMIG auditors completed the audit, which covered four years of Medicaid-funded services.  The final report (#09-1849) is available on OMIG’s Web site (here).