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NEW YORK---A medical services provider in New York City and Long Island was barred by the State Department of Health (DOH) from further participation in New York State's multi-billion dollar Medicaid program after State Comptroller's office auditors identified nearly $1.3 million in Medicaid overpayments to the provider due to overbilling and claims billed at higher-than-allowable rates.
The provider, Signature Health Center, had been paid $25 million in Medicaid claims since January 2001. Based on the findings of both the Comptroller's office and a separate report by the Office of the Medicaid Inspector General, DOH terminated Signature from participation in the Medicaid program effective August 21, 2006. The Comptroller's office audit was issued Monday.
Signature initially refused to allow auditors to review its Medicaid billings and the audit proceeded only after the Comptroller's office successfully pursued litigation against the company.
"Many New Yorkers depend on Medicaid for vital health care services. It is critical that every dollar meant for health care goes for health care," comptroller Alan Hevesi said. "I am pleased that our auditors' findings helped to ensure that Signature will no longer be submitting fraudulent billings to the Medicaid program."
If patients are eligible for both Medicare and Medicaid, Medicare generally covers 80 percent of the cost of a medical treatment or procedure. Service providers such as Signature must enter the amount covered by Medicare in their claims to Medicaid. Auditors examined an initial sample of 125 claims for recipients eligible for both programs and found that 99 (79 percent) were overpaid. For most of the overpayments (90 out of 99), Signature had erroneously reported that Medicare did not pay any of the claim, which meant that it received a larger amount then it should have. For the other nine overpayments, Signature had reported the amount billed to Medicare rather than the amount approved by Medicare - which is usually lower - thereby inflating the amount to be paid by Medicaid.
Auditors' analysis of an expanded sample of Signature Medicaid claims from January 2004 through May 2006 determined that Signature received $831,000 in Medicaid overpayments, mostly through failure to report or underreporting of Medicare receipts. In addition, auditors estimated $455,000 in overpayments to Signature for the period from January 2001 through December 2003.
Auditors also found that podiatrists working for Signature were prescribing medication that did not relate to conditions of the foot, in violation of State Education Law. Four podiatrists wrote a total of 164 prescriptions for drugs used to treat acid reflux, elevated cholesterol, depression, erectile dysfunction, schizophrenia, sleep disorders and other conditions.
In its response to the audit DOH indicated that it would work to recoup a significant portion of the overpayments to Signature.
Signature Health Center provided orthopedic, chiropractic, gynecological, podiatric and general medicine services from offices in the Bronx and Hempstead.
http://www.osc.state.ny.us/audits/allaudits/093007/06s59.pdf
11-27-06
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© 2006 North
Country Gazette
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