STATE OF NEW YORK
OFFICE OF THE MEDICAID INSPECTOR GENERAL
250 Veterans Highway, Room 4A12
Hauppauge, New York 11788
(631) 952-6386
Fax: (631) 952-6415
GEORGE E. PATAKI / KIMBERLY A. O’CONNORGOVERNOR / MEDICAID INSPECTOR GENERAL
November 28, 2006
Dr. Laurence W. Aronstein, Superintendent
Glen Cove City School District
150 Dosoris Lane
Glen Cove, NY 11542
Re: CAR # 06-1087
Provider # 01734096
Dear Dr. Aronstein:
This letter is the final notification of our findings from our recently completed review of the documentation supporting claims that Glen Cove City School District (CSD) submitted under the School Supportive Health Services Program (SSHSP). The SSHSP assists school districts in obtaining federal Medicaid funds for certain diagnostic and health related services that traditionally have been funded exclusively through educational resources.
PURPOSE AND SCOPE
The purpose of this Corrective Action Review was to ensure compliance with applicable Federal and State laws, regulations, rules, and policies governing the New York State Medicaid Program and to verify that:
· Medicaid reimbursable services were rendered for the dates billed;
· Appropriate rate codes were billed for services rendered; and
· Student-related records contained the documentation required in the SSHSP Medicaid Claiming Handbook (#5, and/or #6) and all applicable updates.
The scope consisted of a review of 103 sample claims, representing each type of service for which Glen Cove CSD received Medicaid payments, totaling $38,600.70, during the period February 10, 2005, through February 9, 2006.
SUMMARY
Glen Cove CSD’s Medicaid records were organized, but some claims were not supported by adequate documentation. There were 5 sampled claims identified, totaling $1,459.32, that must be voided. In addition, there were 13 claims related to the sampled claims, which were not covered by an order or not listed on an Individualized Education Program (IEP) for the school year, totaling $4,076.63 that must be voided. We found 1 service category that has systemic errors (2 or more of the same type of error within a service category).
-2-
DETAILED FINDINGS
UNALLOWABLE CLAIMS
Comprehensive Psychological Evaluation
For sampled claims number 5, 7 and 12, the District did not provide the evaluation reports to support the claims.
The Medicaid Claiming/Billing Handbook states, “Comprehensive Psychological Evaluation is a diagnostic evaluation and testing to study and describe a student’s developmental, learning, behavioral and other personality characteristics. It includes social history which means a report of information gathered and prepared by qualified school district or preschool personnel pertaining to the interpersonal, familial and environmental variables which influence a student’s general adaptation to school or preschool, including but not limited to data of family composition, family history, developmental history of the student, health of the student, family interaction and school or preschool adjustment of the student.”
Update # 5, page 1
This error resulted in an overpayment of $936.00. The school district is to void these claims. Due to the systemic determination of these errors, the school district is to review comprehensive psychological evaluation claims for evaluation reports, retroactive to July 1, 2002, and void any that are inappropriate.
Occupational Therapy
For sampled claim number 54, the District did not provide an order to support the claim.
The Medicaid Claiming/Billing Handbook states, “Occupational therapy orders must be signed and dated by a licensed physician or licensed nurse practitioner and must also cover the billing period.” Update # 5, page 12
This error resulted in an overpayment of $422.00. The school district is to void this claim. There were an additional 9 occupational therapy claims related to the sampled error claim, totaling $3,798.00 that must be voided, where services for the school year were provided without supporting orders. This brings the total amount to be voided to $4,220.00.
Special Transportation
For sampled claim number 101, special transportation was not listed on the student’s IEP.
The Medicaid Claiming/Billing Handbook states, “Special transportation must be indicated on the student's IEP.”
Update # 5, page17
This error resulted in an overpayment of $101.32. The school district is to void this claim. There were an additional 4 special transportation claims related to the sampled error claim, totaling $278.63 that must be voided, where services for the school year were claimed without being listed on the student’s IEP. This brings the total amount to be voided to $379.95.
-3-
IMPACT
The total Medicaid overpayment for this review is $5,535.95. These findings were discussed with responsible school district staff at our exit conference of July 13, 2006. We were informed that the District would void all inappropriate claims and initiate corrective action. Within 60 days of the issuance of this letter, please submit to Karen Brown:
· Documentation of claims voided including identifying sample number, date(s) of service, eMedNY cycle number and date voided.
· A written explanation of corrective action taken by the school district.
The Office of the Medicaid Inspector General may follow-up with the Glen Cove CSD to determine if the needed corrective action identified during this review has been implemented.
Thank you for your cooperation in this matter. If you have any questions related to this review, please contact Karen Brown at (631) 952-6403.
Sincerely,
DBM by Denise Marshall
D. Bruce Malito, Director
Long Island Regional Office
Enclosure
cc: Robert Scalise, SED
Mary Murphy, Director of Special Education.