OIG issues final report on DME Medicaid claims in N.Y.

The Office of Inspector General (OIG) has issued a final report on the "Review of Durable Medical Equipment Providers' Medicaid Claims for N.Y. Residents of Assisted Living Programs." OIG found that the durable medical equipment providers improperly received Medicaid reimbursement for medical supplies and equipment not requiring prior approval that were furnished to assisted living program (ALP) residents. As a result $406,081 in federal funds was improperly claimed under the Medicaid program. OIG has recommended that the state refund $406,081 to the federal government; establish eMEDNY edits and controls necessary to deny DME provider claims for Medicaid reimbursement for medical supplies and equipment not requiring prior approval that were furnished to ALP residents; and issue guidance to DME providers emphasizing that state regulations prohibit Medicaid payment for items included in the ALPs' per-diem rates. The state generally concurred with all three recommendations.

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