The Schenectady ARC allegedly owes the state more than $300,000 after an audit revealed a good portion of the agency’s records did not conform to state requirements.
The errors ranged from basic omissions to missing documentation the state requires to show a reimbursed service was actually rendered.
Read the entire audit on the Capital Region Scene blog.
The Office of the Medicaid Inspector General said if it had reason to believe any fraud had occurred, it would have partnered with law enforcement to launch an investigation, but spokeswoman Wanda Fischer said it was more likely simply negligence.
“This is not fraud,” she said. “It’s just a routine audit, but it’s still a fairly big chunk of change. We do believe this is a situation where there were documentation problems. Normally, when someone gets an audit like this, they go in and look at internal controls and make corrections so it doesn’t happen again.”
Schenectady ARC Executive Director Kirk Lewis said this morning that his agency plans to challenge the audit findings because the OMIG audit applied "a completely different standard" than the state Office for Persons with Developmental Disabilities, which oversees such facilities.
The local ARC is one of 57 chapters across the state that provide people with developmental disabilities a variety of services, including physical, speech and occupational therapies and medical, psychiatric, residential, transportation and employment services.
In particular, the state performed an audit of the ARC’s Medicaid Service Coordination program, which uses state funds to provide services and support that addresses an individual’s needs. A random sampling of 100 service records from October 2003 to December 2006 turned up 56 claims that had at least one error and didn’t comply with state requirements.
“Medicaid service coordination is crucial to the quality of life for persons with developmental disabilities,” said Medicaid Inspector General James C. Cox. “Without a commitment to proper service coordination and individualized service plans, an organization may be demonstrating a deficiency for the Medicaid consumers who depend on the Medicaid program, and taxpayers should not be footing the bill for this.”
The audit was conducted from 2010 to 2011, when the OMIG dedicated most of its time to auditing facilities overseen by OPWDD. Typically, Fischer said, the facility being audited agrees to repay Medicaid overpayments by having the state withhold a portion of its future payments.
Of the 56 noncompliant claims, 25 were missing notes required to document Medicaid service coordination. These demonstrate who receives a particular service, when the service was provided, what the service entailed and whether it fulfilled its purpose. Nineteen of the claims indicated individualized service plans were distributed after the 45 days required by the state agency. Nine of the claims were missing required elements of the individualized service plan, which details assessments of a recipient, the services they receive, how long they receive them and more.
The rest of the claims were out of compliance because of missing signatures, delays in completing individualized service plans and even entire Medicaid service agreements that were missing altogether.
“Medicaid service coordination is a real crucial thing for people with developmental disabilities,” said Fischer. “When somebody is trying to learn how to be independent, a coordinator plays a very crucial role in that person’s life skills. So if the coordination is not taking place or you can’t prove that it is taking place through documentation, then that can be a real bump in the road for the people who are expecting that service coordination.”
OMIG said the total amount it is owed is $316,018.