November 22, 2016
In a settlement agreement (PDF) with the New York State Office of the Attorney General, Capital Region BOCES has agreed to repay $2 million for failing to properly document Medicaid-eligible services provided to students in BOCESâ€™ special education programs.
BOCES does not bill Medicaid directly, but school districts do â€“ and they rely on BOCES to provide them with accurate records to substantiate their claims for reimbursement on Medicaid-eligible services.
The Attorney Generalâ€™s audit looked at occupational therapy, physical therapy, speech and social work services delivered by the Capital Region BOCES over three school years: 2010-11, 2011-12, and 2012-13. As a result of the audit, a portion of the reimbursed claims have now been ruled invalid. Capital Region BOCES has agreed to repay the state $2 million for those invalidated claims.
Despite finding errors in the documentation of services that were later billed for Medicaid reimbursement, the audit found no intentional wrong-doing on the part of BOCES or its staff.
Beginning in 2010, a new Medicaid reporting system was initiated by New York State. The new Medicaid rules required schools and BOCES to implement a new record-keeping system that is more akin to that used by doctorsâ€™ offices. That year, for the first time, education service providers were required to begin tracking their time in half-hour increments, keeping contemporaneous case notes and assigning detailed service codes to their work with students.
The audit concluded that the majority of errors were made during the 2010-11 school year, which was the first year under these new requirements. There were significantly fewer errors in the following two years.
â€œIt has been a difficult learning experience for all involved,â€� said BOCES Chief Executive Officer John Yagielski. â€œWe deeply regret the errors that occurred in prior years and have worked closely with auditors from the Attorney Generalâ€™s office to help identify and fix where we had problems. In fact, the audit was initiated as a result of BOCES self-reporting errors it had discovered back in 2012,â€� Yagielski said. â€œWeâ€™ve since taken aggressive steps to build confidence in our service delivery and Medicaid record-keeping processes moving forward.â€�
For example, BOCES instituted a Medicaid Compliance Plan in 2012 and now audits 30 days of each BOCES service providerâ€™s data entries annually, applying the same methodology used by the attorney general and the state comptrollerâ€™s offices.
â€œWe learned a great deal from this audit and appreciate the advice we received from the Attorney Generalâ€™s Office,â€� Yagielski said. â€œA robust system of checks and balances is now in place under the leadership of our Medicaid Compliance Officer Michele Handzel. Weâ€™ve also implemented a team approach within the BOCES to ensure the accuracy of our Medicaid record-keeping. This includes improved training and supervision for our therapists and social workers and regular review of their records to catch any errors before they are sent to school districts.â€�
BOCES has also worked to facilitate closer communication with each studentâ€™s home school district to refine billing practices and improve the overall delivery of services to students with special needs.
Once officials at Capital Region BOCES knew the Attorney Generalâ€™s Medicaid audit would result in invalidated claims, steps were taken to set aside funds to cover the cost of a repayment.
â€œOur goal was to try to insulate our districts from the errors made at BOCES and to budget responsibly for what we knew would be a sizeable liability,â€� said Yagielski. â€œFurther, weâ€™ve kept our component school superintendents informed about the audit and how we planned to repay the state for disallowed claims.â€�
Capital Region BOCES serves approximately 780 students with
special needs in the greater Capital Region and currently employs 13
occupational therapists, 8 physical therapists, 17 speech
therapists, and 19 social workers in its Special Education Division.