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The Office of Inspector General (OIG) for Department of Health and Human Services has found that another major school system, New York City, is significantly out of compliance with the federal Medicaid regulations. The OIG recently released a report recommending that the New York State implement corrective measures to comply with federal/state Medicaid regulations and refund almost $436 million for improperly billing for SLP services from 1993 - 2001. The report, entitled Review of Medicaid Speech Claims Made by the New York City Department of Education, can be found on the OIG's Web site at http://oig.hhs.gov/oas/reports/region2/20201029.htm.
A story on the New York Times web site (June 23) by Clifford Levy publicized the OIG findings. That story can be viewed at http://www.nytimes.com/2005/06/23/nyregion/23students.html?ex=1120190400&en=b9dc957cd6af62c4&ei=5070&emc=eta1.
In brief, the OIG reviewed a sample of 100 claims made during that period and found that 68 contained more than one deficiency. Among the deficiencies reported are:
- 76 claims for services were not provided by or under the direction of an individual holding the Certificate of Clinical Competence in Speech-Language Pathology (CCC-SLP) or an individual with similar qualifications.
- 42 claims were unable to verify that the services billed were rendered.
- 43 claims lacked a referral by an appropriate medical professional.
Over recent years, the OIG has audited approximately 20 Medicaid school-based programs. In five of these audits, the OIG found that SLP services were not being provided in compliance with federal provider qualification requirements.
Resources that ASHA members can utilize to facilitate school administrators understanding and compliance with Medicaid regulations regarding appropriate billing for SLP and hearing services are available through ASHA's Reimbursement site on Medicaid (members only). An update on the continuing Medicaid audits in schools is scheduled to appear in an upcoming issue of the ASHA Leader. For more information, please contact Ingrida Lusis, ASHA's Director of Health Care Regulatory Advocacy, via email at ilusis@asha.org or by phone at 800-498-2071, ext, 4482.
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