United Cerebral Palsy (UCP) of Ulster County was overpaid $2.27 million by New York State’s Medicaid program, discovered after two audits completed by the Office of the Medicaid Inspector General (OMIG) found issues resulting mainly from excessive levels of missing documentation.
The audits reviewed UCP’s day treatment program services. Under day treatment, persons with developmental disabilities receive a comprehensive array of coordinated services designed to promote and attain independence, inclusion, and productivity in the community.
Out of 200 records that were reviewed as part of the audit, 107 contained deficiencies. The largest single category of error involved missing documentation that would have provided evidence that a physician had reviewed an individual’s treatment plan. Other findings included missing records that would prove that a service has been provided or missing progress notes, despite the fact that services had been billed and paid by Medicaid.
“Physicians must authorize services, and their medical knowledge is the cornerstone of establishing medical necessity,” said Medicaid Inspector General James C. Cox. “Without proof that a doctor has ordered a service, no one can verify that a service should have—or was—provided.”
These audits are part of OMIG’s overall effort to fight fraud, waste, and abuse in the Medicaid program. In the first six months of 2013, OMIG identified more than $100 million in Medicaid overpayments, according to preliminary audit, investigative and data match findings. From January 1 to June 30, 2013, findings totaled $103 million; the previous high for six months was $111 million. Actual cash recoveries also increased during the same period by 21.5 percent over the previous year to $61.7 million, according to the same six-month preliminary audit, investigation, and data match numbers.
Audits such as those completed at these day treatment programs are an important component OMIG’s overall effort to fight fraud and recover improper payments in the Medicaid program, according to Cox. “One of the Medicaid program’s goals is to provide excellent health care at a cost that taxpayers can afford,” he notes. “Our work helps to contain costs while improving health care access and quality for Medicaid consumers.”
New Yorkers can assist the Office of the Medicaid Inspector General in fighting fraud, waste, and abuse by reporting potentially suspicious behavior or incidents. OMIG encourages anyone who observes instances of potential Medicaid fraud, waste, or abuse to contact OMIG’s fraud hotline at 1-877-87-FRAUD or visit the Web site at www.omig.ny.gov Tips can be completely anonymous and OMIG investigates information from all calls.