Feds probe Medicaid payments to 9 facilities for developmentally disabled

Federal officials have launched an inquiry into Medicaid payments to nine state institutions for the developmentally disabled, after the Poughkeepsie Journal revealed the facilities had reimbursement rates of $4,556 per day for each of 1,400 residents.

The U.S. Centers for Medicare & Medicaid Services announced the probe Thursday, when it released a Tuesday letter to the state Department of Health. In it, Sue Kelly, CMS associate regional administrator, asked the state to justify the rates, the highest in the nation by one study.

"It has come to CMS attention that several New York state operated developmental centers currently claim ... daily Medicaid rates in excess of $4,500 per beneficiary," said the letter to Donna Frescatore, deputy commissioner of health. "CMS is requesting that New York provide us with additional information about these claims."

While the facilities are operated by the state Office for People with Developmental Disabilities, the Health Department has chief rate-setting authority.

Nicole Weinstein, a spokeswoman for the disabilities agency, said in response, "We will be in discussion with DOH."

Health officials said they would share their response to the federal government after a letter is written.

Specifically, the federal agency — which pays half the rate as part of a 50-50 state-federal match — requested that the state provide:

• a "detailed description" of how the rates are developed and how they "comport with the methodology" in a federally approved rate-setting agreement;
• total Medicaid payments and operating and capital costs for each institution;
• and documents showing that New York's rates do not exceed what's called the "upper payment limit," which prohibits payments above a "reasonable" threshold.

"New York has made assurances to CMS that its ... rates are set at the lower of actual facility operating costs ... and that the level of costs reimbursed does not exceed the upper payment limit," the letter said....more

Here is an interesting comment from CallMeJoe84:
 
If anyone out there thinks that NYS OMRDD is paying over $4,000/person per day to serve the developmentally disabled in their state institutions, I have a bridge to sell you.

Here's how the fraud works. The money comes in from the Feds and the developmental disabilities institutions filter the money to the state for the state to pay for other state (and personal ) obligations with Federal taxpayer money. Some of the money goes to paying state employee salaries, some of the money go to no-bid contracts where the provider is a friend, political contributor or family member of the state employee or elected official. This money is then siphoned through these contractors, salaries and charities as payoffs to support the swamp of nepotism NYS calls Albany.