N.Y. jew homecare provider rips of $8.2m from fed. (state approves)

[Terry R.]

http://oig.hhs.gov/oas/reports/region2/21001002.pdf

Of the 100 claims in our random sample, 61 claims complied with Federal and State requirements, but 39 claims did not. Of the 39 claims, 2 contained more than 1 deficiency.
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These deficiencies occurred because (1) Jewish Home and its contracted home health providers did not comply with certain Federal and State requirements and (2) the State agency did not effectively monitor Jewish Home for compliance with certain Federal and State requirements.

Based on our sample results, we estimate that the State agency improperly claimed $8,177,970 in Federal Medicaid reimbursement during our January 1, 2006, through June 30, 2009, audit period.
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We recommend that the State agency:

• refund $8,177,970 to the Federal Government and
• improve its monitoring of Jewish Home and its contracted home health providers to ensure compliance with Federal and State requirements.
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In its comments on our draft report, Jewish Home disagreed with our findings and recommended financial disallowance. Specifically, Jewish Home stated that our application of Federal and State regulations was “hyper-technical” and that our interpretation of the regulations was both incorrect as a matter of law and inconsistent with the State’s LTHHCP audit standards.
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In written comments on our draft report, the State agency disagreed with both of our recommendations. The State agency stated that our first recommendation (financial disallowance) is based on a misinterpretation of program requirements. Specifically, the State agency stated that neither Federal regulations at 42 CFR § 440.70(a)(2) or State regulations at 10 NYCRR § 763.7(a)(3) “implicitly require a physician’s signature on the plan of care; only a physician’s review is required.”