An audit of the Medicaid program at a Westchester outpatient developmental disability service provide found that they overcharged taxpayers more than $254,000.  The service provider, Abbott House, located in Irvington, NY, will now be required to repay the amount to the state Medicaid program, according to the Office of the Medicaid Inspector General (OMIG).

Outpatient services provided to persons with developmental disabilities are offered at programs licensed by the Office for People with Developmental Disabilities (OPWDD). The purpose of these programs is to offer a comprehensive system of services, with the goal of promoting and attaining independence, inclusion, and productivity for persons with mental retardation and developmental disabilities. These services are furnished at clinic and day treatment facilities and through home- and community-based federal waiver programs.  Abbott House is one of the providers of these services.

The audit found missing information in Medicaid consumer records needed to support reimbursement for service.  Auditors found that critical components of consumer records were absent, so they could not confirm whether a consumer had responded to treatment. Additionally, Abbott House billed for more days of service than were documented, as well as for services when there was not a required residential habilitation plan. 

“The fact that there was no record of these services being provided raises concerns about Medicaid consumer safety and progress,” said Medicaid Inspector General James C. Cox, “taxpayers should not pay for undocumented services.”

OMIG auditors completed the audit, which covered four years of Medicaid-funded services.  The final report (#09-1849) is available on OMIG’s Web site (www.omig.ny.gov) under the final report section.

New Yorkers can assist the Office of the Medicaid Inspector General in fighting fraud, waste, and abuse by reporting potentially suspicious behavior or incidents.  OMIG encourages anyone who observes instances of potential Medicaid fraud, waste, or abuse to contact OMIG’s fraud hotline at 1-877-87-FRAUD or visit the Web site at www.omig.ny.gov. Tips can be completely anonymous, and OMIG investigates information from all calls.

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Our mission is to enhance the integrity of the New York State Medicaid program by preventing and detecting fraudulent, abusive, and wasteful practices in the Medicaid program and recovering improperly expended Medicaid funds while promoting high-quality patient care.