Feds want New York to return $27.5M in Medicaid payments

As a result, New York received almost $27.5 million from January 2005 to January 2009 in improper federal Medicaid reimbursements, according to the report.

At issue is rehab for youth between the ages of 5 and 19 with “serious emotional disturbances” living in state-provided housing, aimed at preparing them for independent living.

Eligibility depends on a physician’s recommendations and, in order to file a claim, there must be a specific amount of rehab staff visits per month, among other requirements.

While the Centers for Medicare and Medicaid Services (CMS) offer states flexibility in how they implement the program, the report found that rehab providers in New York did not comply with state-level regulations, and the state did not “adequately monitor” the program for errors.

The state fired back that federal regulators are making judgments based on their own version of state rules and are using definitions that are “overly technical and contrary to the meaning and intent of the regulations.”