NYAPRS Note: In another unveiling of Medicaid abuse, NYS is accused of overspending the federal government’s liability by $1.5b. Compared to the previous audit—that claimed $15b in excess over 20 years—this penalty is seemingly minor. However the goals of Cuomo and the Medicaid Redesign Team to keep such close control and accountability over spending may now seem impeachable. And the feds may look with more scrutiny at further reinvestment into the state’s Medicaid program, or allowances for further programmatic and market flexibility.
Feds: State Owes $1.5B
Times Union; James M. Odato, 7/29/2014
Two new federal audits of New York’s massive Medicaid program have concluded that state government must refund $1.5 billion to Washington.
The biggest hit came from an audit by the Centers for Medicare and Medicaid Services (CMS) that was revealed Tuesday at a House Committee on Oversight and Government Reform hearing.
New York Congresswoman Carolyn Maloney, a New York City Democrat, criticized a federal agent for targeting New York.
The new audit found that in the 2010-2011 fiscal year, New York took $1.26 billion more than it deserved to run the subsidized health care program at facilities operated by the state Office for People with Developmental Disabilities.
New York state will appeal, said William Schwarz, a state Department of Health spokesman.
CMS is demanding repayment of the money as it moves ahead with further reviews of Medicaid funding of New York’s developmental centers and care facilities for the 2011 and 2012 fiscal years. Earlier reviews by the federal government determined that the facilities received $15 billion in excessive federal Medicaid resources over a 20-year period.
A separate new audit examining other programs in New York’s $56 billion Medicaid program found that the state received $200 million in extra federal money in recent years. That audit, by the Inspector General of the U.S. Department of Health and Human Services, focused on several programs, in many cases faulting poor documentation and support for reimbursements provided.
During the hearing, John Hagg, director of Medicaid audits for the inspector general, was confronted by Maloney. She asked whether similar findings arose in other states and asked why New York is drawing so much attention.
Hagg said the panel asked his agency to study New York, and noted that excess payments have been found in other states. “New York must do a better job of monitoring providers to ensure that only allowable services are paid,” he said.
Maloney said Gov. Andrew Cuomo has “taken seriously the long-term sustainability of the program” and created a committee to recommend reforms. As a result, she said, $2 billion is being saved in the state’s Medicaid program.
The CMS review found the state’s financial management of the program is lacking. The auditors said that the state has not adequately supported reported costs, didn’t have the proper internal controls, did not comply with federal requirements for establishing a cost allocation plan, and had provided unreliable consolidated fiscal reports for 2010-2011. Auditors also found examples of what seemed to be excessive rates paid for services, particularly at two government-owned hospitals in New York City.
A spokesman for Cuomo did not respond to inquiries about the demands for repayments.
Schwarz, the Health Department spokesman, would not take calls on the audits. He emailed a statement saying that the department will “vigorously appeal this unprecedented decision.”
http://m.timesunion.com/local/article/Feds-State-owes-1-5B-5655516.php