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CRB agrees to repay $2 million for improperly documented Medicaid claims

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 BOCES' special education programs.

BOCES does not bill Medicaid directly, but school districts do -- and they rely on BOCES to provide them with accurate records to substantiate their claims for reimbursement on Medicaid-eligible services.

The Attorney General'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.

Recording errors coincided with the rollout of a new Medicaid reporting system

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 doctors' 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.

"It has been a difficult learning experience for all involved," said BOCES Chief Executive Officer John Yagielski. "We deeply regret the errors that occurred in prior years and have worked closely with auditors from the Attorney General'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," Yagielski said. "We've since taken aggressive steps to build confidence in our service delivery and Medicaid record-keeping processes moving forward."

For example, BOCES instituted a Medicaid Compliance Plan in 2012 and now audits 30 days of each BOCES service provider's data entries annually, applying the same methodology used by the attorney general and the state comptroller's offices.

"We learned a great deal from this audit and appreciate the advice we received from the Attorney General's Office," Yagielski said. "A robust system of checks and balances is now in place under the leadership of our Medicaid Compliance Officer Michele Jones. We'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."

BOCES has also worked to facilitate closer communication with each student's home school district to refine billing practices and improve the overall delivery of services to students with special needs.

Planning for the repayment

Once officials at Capital Region BOCES knew the Attorney General's Medicaid audit would result in invalidated claims, steps were taken to set aside funds to cover the cost of a repayment.

"Our 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," said Yagielski. "Further, we've kept our component school superintendents informed about the audit and how we planned to repay the state for disallowed claims."

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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.

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