OIG: New York State made $1.4B in improper Medicaid payments

New York State improperly made Medicaid payments to managed long-term care plans that failed to comply with contract rules, according to a report by HHS' Office of Inspector General.

The OIG said it examined 100 Medicaid payments to MLTC plans during state fiscal year 2014 and found New York improperly found NY improperly made 36 payments.

"Specifically, New York did not ensure that MLTC plans documented eligibility assessments of program applicants and reassessments of those already in the program, and conducted these assessments in a timely manner," the office added. "New York also did not ensure that the plans provided services to beneficiaries according to a written care plan. Further, New York did not ensure that the plans enrolled and retained only those beneficiaries who required community-based services, and disenrolled beneficiaries who requested disenrollment in a timely manner."

For its report, the OIG said it also consulted with CMS physicians regarding beneficiaries associated with the payments. The office said CMS physicians discovered 71 beneficiaries' MLTC plans were noncompliant with state contract requirements for service planning and care management.

Based on these findings, the OIG recommended state officials "develop procedures to monitor MLTC plans for compliance with federal and state requirements detailed in its contract, including requirements for adequate service planning and care management." The office said it also encouraged New York to "ensure that future contracts include provisions that allow it to recover payments when plans do not comply with contract requirements." The OIG estimated Medicaid could have saved $1.4 billion through such a measure.

New York State did not indicate it agreed or disagreed with the OIG's recommendations, the office said, but "described steps that it has taken to improve its monitoring of the MLTC plans and indicated that it is developing a new contract that will include enhancements to address our concerns."

The OIG added, "New York took exception to our statement that it could have achieved Medicaid cost savings because, during our audit period, New York was not required to include our recommended provisions in its MLTC contracts. We maintain that our recommendations are valid."

 

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