Based on our sample results, we estimated that the State improperly claimed approximately $1.6 million in Federal Medicaid reimbursement for traumatic brain injury (TBI) waiver program services provided by Belvedere of Albany, LLC (Belvedere), that did not comply with Federal and State requirements during calendar years 2005 through 2007. In addition, we estimated that the State claimed $2.1 million in Federal Medicaid reimbursement for services provided by Belvedere that may not have complied with Federal and State requirements. The State's TBI waiver program allows the State to claim Medicaid reimbursement for home and community-based services provided to individuals with TBIs who would otherwise require institutionalization in a nursing home.
We recommended that the State (1) refund $1.6 million to the Federal Government; (2) work with the Centers for Medicare & Medicaid Services to resolve the claims, totaling $2.1 million, for which Medicaid reimbursement may have been unallowable; (3) require the centers to ensure and document that all beneficiaries approved for services have been assessed by certified individuals and are eligible for TBI waiver program services; (4) provide adequate training to assessors on the Federal and State requirements for the TBI waiver program; and (5) require Belvedere to ensure that it documents services billed and claims reimbursement only for allowable TBI waiver program services. The State disagreed with our first recommendation and generally disagreed with our findings. We maintain that our findings and recommendations are valid.
Dallas L Alford IV, CPA is a licensed Certified Public Accountant in the state of North Carolina and owner of Atlantic Financial Consulting, a consulting firm that provides comprehensive medical billing services, practice management consulting, coding audits, Medicare compliance, Medicare RAC support and other general medical practice consulting services.
To learn more about Atlantic Financial Consulting you may visit their website at
http://atlanticfinancial.us or contact Dallas L Alford IV, CPA directly at 1 888-428-2555, Ext. 200.
We recommended that the State (1) refund $1.6 million to the Federal Government; (2) work with the Centers for Medicare & Medicaid Services to resolve the claims, totaling $2.1 million, for which Medicaid reimbursement may have been unallowable; (3) require the centers to ensure and document that all beneficiaries approved for services have been assessed by certified individuals and are eligible for TBI waiver program services; (4) provide adequate training to assessors on the Federal and State requirements for the TBI waiver program; and (5) require Belvedere to ensure that it documents services billed and claims reimbursement only for allowable TBI waiver program services. The State disagreed with our first recommendation and generally disagreed with our findings. We maintain that our findings and recommendations are valid.
Dallas L Alford IV, CPA is a licensed Certified Public Accountant in the state of North Carolina and owner of Atlantic Financial Consulting, a consulting firm that provides comprehensive medical billing services, practice management consulting, coding audits, Medicare compliance, Medicare RAC support and other general medical practice consulting services.
To learn more about Atlantic Financial Consulting you may visit their website at
http://atlanticfinancial.us or contact Dallas L Alford IV, CPA directly at 1 888-428-2555, Ext. 200.
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