Schenectady ARC treated unfairly in Medicaid inspector’s audit
Sch’dy ARC treated unfairly in Medicaid inspector’s audit
Re July 26 article, “State Medicaid audit results in $300K bill for Schenectady ARC”: The statements attributed to the spokesperson for the Office of the Medicaid Inspector General [OMIG] do not accurately portray the circumstances of the audit and they do not accurately present Schenectady ARC’s position.
First, Schenectady ARC is contesting the findings in the final audit report. Although we have until late August to notify the OMIG that we want to have a hearing to contest the findings, attorneys for Schenectady ARC sent a notice to the OMIG’s office of counsel requesting a hearing. That notice was received by the OMIG on July 25.
Second, the statement that there were 56 claims out of the sample of 100 that had one or more errors that did not meet “state requirements” is misleading. What the OMIG fails to say is that there is a substantial dispute as to what the “state requirements” were in order to be paid for providing service coordination.
Prior to 2009, the requirements for documentation were set by the state agency that regulates Service Coordination, the Office for People With Developmental Disabilities (OPWDD, formerly known as OMRDD). Thus, for the time period that was being audited (2003 to 2006), the only “state requirement” that providers like Schenectady ARC were aware of was a statement of 10 elements (documents) that OPWDD said providers must meet in order to bill for Medicaid Service Coordination.
In the fall of 2009, however, the OMIG announced that it was going to audit service providers on a different set of standards. The OMIG audit protocol looked at elements that had never been required to bill for Medicaid Service Coordination. Thus, when the OMIG conducted its audit of Schenectady ARC in 2009, it was holding Schenectady ARC to billing standards that had not been identified at the time the services were provided.
Notably, the services for which Schenectady ARC billed did meet the OPWDD requirements. In the year preceding the OMIG audit, Schenectady ARC’s Medicaid Service Coordination program was audited by OPWDD, and the 50 claims reviewed had a perfect score (all 10 of the required elements were present). Of the 100 claims reviewed by the OMIG in its audit, 99 met the requirements that OPWDD had previously announced. One non-compliant claim out of 150 is a far cry from the “56 claims” that the OMIG refers to in the article. The technical elements that the OMIG added to its audit protocol in 2009 have little relationship to the quality of the service.
We have a rigorous compliance program; we review our claims and our documents, and we take the appropriate steps if we don’t have the documents necessary to bill for a service. There is no way, however, that any provider can audit themselves against standards that were not identified when the services were provided. It is unfortunate that time and attorney’s fees will need to be expended to defend our program from an audit based on billing standards that are being applied retroactively.
The writer is executive director of Schenectady ARC.
You can ‘flame’, but you can’t hide online
There is a need for a worldwide data base connecting every screen name online to a real person. That would encourage people to be more responsible when online, and avoid problems for others and for them.
Suppose you are a young kid who likes to “flame” people online, using obnoxious phrases, confident in your anonymity. A network of nerds decides to end anonymity online by posting every known screen name and tie it directly to a real person.
Millions of screen names will be readily tied to a real person through Facebook and other social media. What if you try hard to maintain your anonymity? Enter the nerds: Using all their skills, they will break down walls of anonymity and thousands of them will spend hours to link just one screen name to a real person.
A key word search is done to see how often in your postings you use the word “idiot” or any of 50 scurrilous phrases. The nerds sell this information to universities, employers and websites. Soon 100 million screen names will be tied to real people.
Your “anonymous” postings online will be with you the rest of your life, with all its implications. A worldwide data base connecting screen names to real people would be better for everybody.
Richard Moody Jr.
Senior citizens can be an undiscovered treasure
For more than 20 years I had the privilege of spending time with hundreds of Niskayuna senior citizens. To say this was just a job would be like saying that the Grand Canyon is just a hole in the ground.
For my colleagues, Susan Leonard and Annette Gaylord, and me this was a grand adventure. We had the unique opportunity to become deeply involved in the lives of a generation of individuals who experienced the Great Depression and World War II, and who worked hard to lay the foundation for the unprecedented American prosperity and growth that followed.
Recently, one of our oldest friends, Irene Van Kamerik, passed away at the age of 92. Irene lived in Niskayuna for more than 50 years and, with her husband Jack and sister Gen Freer, began attending the Niskayuna Senior Center about 25 years ago.
She was kind, generous, and lived life with dignity and integrity. Even though she had her own personal difficulties, she was always cheerful and ready to lend a hand, rarely asking for help.
If you are fortunate enough to have an older person in your life, I encourage you to spend as much time with him or her as you can. You may be surprised to hear how they lived their lives — about their hopes and dreams and about the reality of living during very challenging times.
If not, volunteer at a local senior center, hospital or assisted-living facility, and you might meet someone who was a fighter pilot during the war or who played on the first professional hockey team or who flew around the world before retiring from a job with the airlines.
As for me, I was lucky enough to know each of these individuals and so many more.
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