STATE OF NEW YORK
DEPARTMENT OF HEALTH
250 Veterans Highway – Room 4A12, Hauppauge, NEW YORK 11788
Antonia C. Novella, M.D., M.P.H., Dr.P.H. Dennis P. Whalen
Commissioner Executive Deputy Commissioner
November 28, 2005
Mr. Michael Mostow, Superintendent
Patchogue-Medford Union Free School District
241 S Ocean Ave.
Patchogue, NY 11772
Dear Superintendent Mostow:
This letter is the final notification of our findings from our recently completed review of the documentation supporting claims that Patchogue-Medford Union Free School District (UFSD) submitted under the School Supportive Health Services 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.
PURPOSE AND SCOPE
The purpose of this Corrective Action Review was 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.
The scope consisted of a review of 123 sample cases representing each type of service for which Patchogue UFSD received Medicaid payments during the period March 31, 2004, through March 30, 2005.
SUMMARY
Patchogue-Medford Union Free School District records were well-organized and generally provided required documentation. There were three cases identified in which the claims must be voided in the amount of $1,494.97:
· 1 billed initial Individualized Education Program (IEP) never took place.
· 1 billed triennial (IEP) had no record of service.
· 1 special transportation, service month, was not listed on the IEP.
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DETAILED FINDINGS
UNALLOWABLE CLAIMS
Initial IEP not Done
For sample #86, the student moved before the scheduled Committee on Special Education meeting took place and no IEP was completed.
This error resulted in an overpayment of $775.00. The school district is to void this claim.
Missing Triennial IEP
For sample #103, neither the IEP nor the meeting notes from the Committee on Special Education could be located.
This error resulted in an overpayment of $492.00. The school district is to void this claim.
Service Not Listed on IEP
For sample #118, the IEP did not list special transportation as a service to be provided.
This error resulted in an overpayment of $227.97. The school district is to void all special transportation claims in the review month and all claims associated with the service for the period covered by the IEP.
The attached Exhibit provides a summary of unallowable claims.
CORRECTIVE ACTION
Incorrect Number of Services Claimed
The school district claimed the incorrect number of services in 8 separate service months:
· Sample #14, 10 nursing services billed while 8 were actually received.
· Sample #18, 16 nursing services billed while 8 were actually received.
· Sample #19, 17 nursing services billed while 14 were actually received.
· Sample #21, 11 nursing services billed while 10 were actually received.
· Sample #73, 5 occupational therapy services billed while 7 were actually received.
· Sample #75, 6 occupational therapy services billed while 5 were actually received.
· Sample #52, 11 speech therapy services billed while 13 were actually received.
· Sample #55, 7 physical therapy services billed while 8 were actually received.
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The errors with incorrect monthly service amounts had no dollar impact and do not require any claim adjustments since the threshold payment for each month was reached. However, it is important that the number of claims be reported correctly because they are used in formulating school district reimbursement amounts.
Improper Social History
There were 5 comprehensive psychological evaluations, sample #s 23, 24, 25, 28 and 31, where a parent completed the social history.
A qualified school professional should sign–off on any social history completed by a parent.
IMPACT
These issues were discussed with responsible school district staff at our exit conference of October 24, 2005. We were informed that the District would void all inappropriate claims. In addition, the district has initiated corrective action regarding social history prepared by the parent. Qualified school professionals are being provided with a social history form that requires their signature. Within 60 days of the issuance of this letter, please submit to Sander Levine:
· Documentation of claims voided including identifying sample number, date(s) of service, eMedNY cycle number and date voided.
Thank you for your cooperation in this matter. If you have any questions related to this review, please contact Sander Levine at (631) 952-6387.
Sincerely,
Bruce Malito as per Sander Levine
D. Bruce Malito, Director
Long Island Medicaid Audit Operations
Office of Medicaid Management
Division of Fraud Control and Program Integrity
cc: Robert Scalise, SED
Margory Bernstein Asst. Supt.