Schenectady ARC will repay New York State’s Medicaid program $316,018, following an audit conducted by the Medicaid Inspector General (OMIG), that revealed problems with documentation for Medicaid service coordination for Medicaid consumers.

Medicaid service coordination (MSC) is a Medicaid State Plan service provided by the Office for People with Developmental Disabilities (OPWDD) to assist persons with developmental disabilities and mental retardation in gaining access to necessary services and supports that appropriately address each individual’s needs.  Qualified service coordinators provide MSC by developing an individualized service plan (ISP) by evaluating each individual, identifying the person’s desired outcomes and coordinating the access and delivery of appropriate supports and services.  The service coordinators are also responsible for ensuring that the ISP and MSC agreements are kept up-to-date and revised on an as-needed basis.

Out of a random sample of 100 service records at Schenectady ARC, OMIG’s audit found 56 contained at least one error and did not conform to state requirements. Twenty-five of the records were missing notes required to document Medicaid service coordination, while 19 indicated that distribution of individualized service plans exceeded the required 45-day limit.  

“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 covered four years of Medicaid-funded services. The final report (#09-5246) can be found on OMIG’s Web site at 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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