Some of the New York State Department of Health’s (State agency) claims for Federal Medicaid reimbursement for Long-Term Home Health Care Waiver Program (LTHHCP) services did not comply with certain Federal and State requirements. On the basis of our sample results, we estimated that the State agency improperly claimed at least $2.6 million in Federal Medicaid reimbursement for unallowable LTHHCP services.

The State agency made claims for unallowable LTHHCP waiver services because its monitoring activities did not ensure that (1) services were provided in accordance with each beneficiary’s plan of care, (2) documentation supported services billed, (3) level-of-care assessments were documented timely, (4) each beneficiary’s residence was a suitable environment for their receiving services, and (5) beneficiaries were eligible to receive waiver program services based on their level-of-care assessment.


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