On August 18, 2009, the Office of the Medicaid Inspector General (OMIG) announced its plan to aggressively address areas of the Medicaid program that are vulnerable to improper payments, including claims submitted for medical services provided to deceased beneficiaries.
As a follow-up to that announcement, on December 1, 2009, OMIG sent letters by certified mail to 276 providers who had submitted claims during October 2009 for services provided to beneficiaries who had been reported to OMIG as deceased. The OMIG asked those providers to “review the claims and provide information, including the name and title of the person who performed the service, the name and title of the person who prepared the claim submitted to Medicaid, and all records which support the billing of each claim.”
The OMIG gave providers two weeks in which to respond to the inquiry with the requested evidence. The December 1, 2009 letter indicated that providers who billed for services subsequent to the date of a beneficiary’s death and did not provide an appropriate response to OMIG’s questions would find their names posted on the OMIG Web site.
Medicaid providers are required, as a condition of their participation in the Medicaid program, “to prepare and maintain contemporaneous records demonstrating its right to receive payment…all records necessary to disclose the nature and extent of services furnished…” The Medicaid provider is required to furnish such records, upon request, to oversight agencies which request them.
According to 18 NYCRR 515.2 (b) (6) of Department of Health regulations, those providers who fail to provide the records can be charged with “an unacceptable practice” under the Medicaid program. “Failing to maintain or make available for purposes of audit or investigation records necessary to fully disclose the medical necessity for and the nature and extent of the medical care, services or supplies furnished” can be the basis for a censure or exclusion from the program.
The OMIG will continue to perform data mining operations on a periodic basis to identify billing for services provided to deceased beneficiaries.
Providers with questions should contact Theresa Gulum at 518-402-1464 (e-mail: Theresa.Gulum@omig.ny.gov).
The following providers failed to respond to the OMIG’s December 1, 2009 letter as of the date of this posting. The OMIG has confirmed the beneficiary was deceased prior to the claim service date.
* Click on a header to sort the provider list.
Provider Name
Provider Type
Location
ONG KENNETH MD
PHYSICIAN
ROCKLAND
The following providers failed to respond to the OMIG’s December 1, 2009 letter and to follow-up phone calls from OMIG staff as of the date of this posting. The OMIG is awaiting formal death certificates to confirm that the beneficiary was deceased prior to the claim service date, although there was a reported date of death.
* Click on a header to sort the provider list.
Provider Name
Provider Type
Location
C&C HOMECARE INC
MEDICAL APPLIANCE DEALER
NASSAU
HOME MEDICAL SPECIALTIES INC
MEDICAL APPLIANCE DEALER
QUEENS
EGAN DANIEL MD
PHYSICIAN
NEW YORK
Statistical Information
The remaining 265 providers responded as follows:
66 providers indicated the beneficiary was deceased at the time of service and the claim was submitted as a result of a billing error. The OMIG continues to evaluate those provider responses.
55 providers relied on Medicaid eligibility records and/or caregiver statements that indicated the beneficiary was alive at the time services were provided. The OMIG continues to evaluate the appropriateness of these claims.
144 providers indicated that the beneficiary was alive at the time service was provided. The OMIG continues to evaluate the appropriateness of these claims.
Our mission is to enhance the integrity of the New York State Medicaid program by preventing and detecting fraudulent, abusive and wasteful practices within the Medicaid program and recovering improperly expended Medicaid funds while promoting high-quality patient care.
Copyright 2012 New York State Office of the Medicaid Inspector General. All rights reserved.
