New York Claimed Federal Reimbursement for Some Assertive Community Treatment Services That Did Not Meet Medicaid Requirements
New York claimed Federal Medicaid reimbursement for some Assertive Community Treatment (ACT) services that cannot comply with Medicaid requirements. Specifically, of the 100 claims in our random sample, 87 claims complied with Medicaid requirements, but 13 claims did not.
Providers did not always ensure that ACT services were provided in accordance with a beneficiary ½s treatment plan and did not always verify that the required number of contacts needed to claim the ACT full payment rate was provided. Further,
certain providers failed to maintain or provide documentation to support ACT services claims. Last, although New York monitors ACT providers for compliance with Medicaid requirements, it did not ensure that our oversight was effective
in preventing the errors identified in our review. 
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Translation
We recommended that New York (1) refund $4.4 million to the Federal Government, (2) ensure that ACT program guidance on claiming Medicaid reimbursement for services is reinforced with
providers, and (3)�continue to improve its monitoring of the ACT program.
Filed under: Centers for Medicare and Medicaid Services