Audit Finds $316K in Medicaid Overpayments

Schenectady ARC received $316,018 in overpayments from the Medicaid program, according to an audit conducted by the Medicaid Inspector General (OMIG). The audit revealed issues with documentation for Medicaid service coordination for Medicaid consumers.

Medicaid service coordination (MSC) is a Medicaid State Plan service provided by the Office for People with Developmental Disabilities (OPWDD) to assist persons with developmental disabilities and mental retardation in gaining access to necessary services and supports that appropriately address each individual’s needs.  Qualified service coordinators provide MSC by developing an individualized service plan (ISP) by evaluating each individual, identifying the person’s desired outcomes and coordinating the access and delivery of appropriate supports and services.  The service coordinators are also responsible for ensuring that the ISP and MSC agreements are kept up-to-date and revised on an as-needed basis.

Out of a random sample of 100 service records at Schenectady ARC, OMIG’s audit found 56 contained at least one error and did not conform to state requirements. Twenty-five of the records were missing notes required to document Medicaid service coordination, while 19 indicated that distribution of individualized service plans exceeded the required 45-day limit.  

“Medicaid service coordination is crucial to the quality of life for persons with developmental disabilities,” said Medicaid Inspector General James C. Cox. “Without a commitment to proper service coordination and individualized service plans, an organization may be demonstrating a deficiency for the Medicaid consumers who depend on the Medicaid program, and taxpayers should not be footing the bill for this.”

The audit covered four years of Medicaid-funded services. The final report (#09-5246) can be found on OMIG’s Web site here.