3
/ STATE OF NEW YORKDEPARTMENT OF HEALTH
584 DELAWARE AVENUE, BUFFALO, NEW YORK 14202
Antonia C. Novello, M.D., M.P.H., Dr.P.H. / Dennis P. Whalen
Commissioner / Executive Deputy Commissioner
October 18, 2005
Mr. Paul Hashem, Superintendent
Lackawanna City School District
245 South Shore Boulevard
Lackawanna, New York 14218
Re: Lackawanna City School District
Audit #05-1262
MMIS #01368996
School Supportive Health Services Program
Dear Mr. Hashem:
This letter is the final notification of our findings from our recently completed review of the documentation supporting claims that Lackawanna City School District submitted under the School Supportive Health Service 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.
The purpose of this Corrective Action Review is 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 all applicable updates.
We reviewed 80 claims representing $27,375.94 in services billed from January 27, 2004 through January 26, 2005. Each type of service billed by Lackawanna City School District was included in our sampled claims.
Lackawanna City School District’s Medicaid claims were supported by adequate documentation. We found no errors in our sampled review. However, due to an incorrect application of claiming instructions for Initial Individual Education Program (IEP) Reviews, the school district incorrectly billed 56 claims totaling $43,400.00 which must be voided (see Schedule of Payments to be Voided).
DETAILED FINDINGS – CLAIMS TO BE VOIDED
Incorrectly Billed Claims
As indicated on page 20 of the School Supportive Health Services Medicaid Claiming/Billing Handbook (Update #5), “An initial can only be billed when an unclassified student is referred to the CSE for an initial IEP and a CSE meeting is held.” Since these incorrectly billed claims were systemic in nature, we expanded the scope of our review to cover dates of payment from July 1, 2002 through March 31, 2005. We found that 56 claims for Initial Reviews totaling $43,400.00 were billed for students already classified as having a disability.
Some of these claims may be re-billed at the lesser rate for either an Amended Review ($520.00), or a Re-evaluation Review ($492.00), as outlined in the SED January 2002 Memorandum – Students Transitioning from Preschool to School Age. Re-billing may further be restricted by the requirement that no more than three billings in a nine-month period are submitted for an Amended Review, or one billing per nine-month period is submitted for a Re-evaluation Review.
RECOMMENDATION
The Lackawanna City School District has not billed Medicaid for School Supportive Health Services (SSHS) since March, 2004. Medicaid payments totaled $533,370 for 2003 and $355,009 for the period January 1, 2004 through March 31, 2004. This district provides services for a large number of Medicaid eligible students classified as having a disability. In 2003, Medicaid SSHS were billed for approximately 250 students.
The Lackawanna City School District should maximize every revenue source available, especially in current times of tight budget constraints. We recommend that the district resume billing of these services immediately.
These issues were presented to school district staff at our exit conference held on August2,2005. At that time, district staff were instructed to void $43,400.00 in payments according to the attached Schedule of Payments to be Voided.
We have requested the Office of Medicaid Management’s Division of Medicaid Fraud Control and Program Integrity, Bureau of Revenue Initiatives, to grant Lackawanna City School District a waiver to allow re-billings beyond the two-year limitation for those affected services cited herein. This waiver has been granted until October 31, 2005 for eMedNY Payment Cycle 1474 processing. To ensure accurate processing, please annotate all adjusted claims with both the original claim reference number and any subsequent claim reference numbers if applicable. Please submit notification to our office when the claims have been voided and any re-billings have been made. The submission should include the date of the voids/re-billings and the eMedNY cycle number. Send notification to:
Ms. Deborah Acanfora
NYS Department of Health
Bureau of Medicaid Audit
Buffalo Medicaid Audit Office
584 Delaware Avenue – 2nd Floor
Buffalo, New York 14202
Fax: 716-847-4553
Per conversations with Lackawanna City School District staff, $43,400.00 of payments per the attached Schedule of Payments to be Voided were voided on August 15, 2005 (cycle #1465). The re-billings were completed on September 19, 2005 (cycle #1470).
If you have any questions related to this review, please contact Ms. Deborah Acanfora at (716)847-5090.
Thank you for the cooperation and courtesy extended to our staff during this review.
Sincerely,
GEM
George E. Meeks, Director
Buffalo Medicaid Audit Office
Western Region
Office of Medicaid Management
GEM:kla
Attachment
cc: Robert Scalise, Medicaid Service Unit Coordinator, SED
Christine Sawran, Principal of Special Education
Sam Masry, Business Manager