The Final Audit Report is titled “Audit of Claims for Family Planning services,” the audit number is 17-3447, and it is dated January 4, 2018. The Final Audit Report is from the Office of the Medicaid Inspector General (OMIG) for the provider, North Central Bronx. The audit was specific to the Medicaid fee-for-service payments for family planning and reproductive health services paid to the provider on behalf of Medicaid beneficiaries while they were enrolled in Health plus. The audit is available at https://omig.ny.gov/images/stories/audit_reports/January2018/17-3447.pdf
The audit’s main aim was to verify that the provider was not in receipt of Medicaid fee-for-service payments for anyone enrolled in a plan where there was a contractual agreement between the plan and the provider. Also, it was meant to verify that the billing of the fee-for-service. Medicaid payment was in accordance with the rules and requirements. The audit findings revealed that $5474.39 Medicaid overpayments where the fee-for-service payments were made to the provider for persons who were enrolled in plans that had participating provider agreements with the provider. OMIG also identified that the interest owed on the overpayments may be collected and has accrued to $935.06, bringing the total amount due to DOH to $6409.45 which is inclusive of interest.
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The provider has two repayment options either to make the full payment by cash/cheque within 20 days of the date of the final audit or get into an agreement with OMIG where the latter may adjust the rate of recovery or require payment in full in the case the balance is not repaid as agreed. The provider, however, has hearing rights and can challenge this action by requesting an administrative within sixty days of the date of the notice.
