OIG auditors were unable to determine if an additional $112 million in non-emergency medical transportation claims complied with state and federal requirements.
Federal auditors say New York City should refund $84.3 million to Medicaid after inspectors uncovered widespread noncompliance and sloppy documentation in claims for non-emergency medical transportation.
The audit by the Department of Health and Human Services -- Office of the Inspector General also was unable to determine if an additional $112 million in federal funding for NEMT providers complied with state and federal regulations.
The audit examined 4,768,858 payments totaling $269,584,249 (federal share) for NEMT services in 2018 and 2019. Inspectors found that only 17 of the 100 payments picked in a random sampling complied with state and federal requirements. Forty-one samples did not comply and auditors could not determine compliance for the remaining 42 samples.
"On the basis of our sample results, we estimated that New York improperly claimed at least $84,329,893 in Federal Medicaid reimbursement for payments to NEMT providers that did not comply with certain Federal and State requirements," OIG says. "In addition, we estimated that New York claimed $112,028,279 in Federal Medicaid reimbursement for payments to NEMT providers that may not have complied with certain Federal and State requirements.
The auditors recommend that New York City refund $84,329,893 to the federal government for the noncompliant payments and further audit the $112,028,279 in questionable payments and refund any money that was inappropriately billed.
In a written response to the audit, New York Department of Health Acting Executive Deputy Commissioner Kristen M. Proud did not comment on the specific recommendations but asked auditors to withdraw the refund request and provide additional documentation for 28 sampled payments.
"Because of the enormous number of people transitioning transportation managers, and the state's moral obligation to ensure that there would be no interruptions in the delivery of medical services, the department directed the new transportation managers to accept the level of transportation previously established for each enrollee," Proud says in a letter to HHS Regional Inspector General Brenda Tierney.
"Neither State statute nor regulation defines a specific period of time for which the written order specifying the appropriate mode is valid," Proud writes. "Based on the foregoing information and the details below, the Department requests that the repayment request be withdrawn from the audit report.
John Commins is a content specialist and online news editor for HealthLeaders, a Simplify Compliance brand.
KEY TAKEAWAYS
The audit examined 4,768,858 payments totaling $269,584,249 (federal share) for NEMT services in 2018 and 2019.
Inspectors found that only 17 of the 100 payments picked in a random sampling complied with state and federal requirements.
Forty-one samples did not comply and auditors could not determine compliance for the remaining 42 samples.
New York officials asked auditors to withdraw the refund request and provide additional documentation for 28 sampled payments.