Medicare Compliance & Reimbursement

One provider found out the hard way:  Medicaid won't pay facility ad and marketing costs.

Providers billing Medicaid need to make sure that their reported costs reflect actual amounts, or a state's attorney general might ask for a refund of Medicaid payments. Further, the AG might also make the provider pay interest on the Medicaid money.

Rosa Coplon Jewish Home and Infirmary, a 180-bed residential health care facility, and its long-term home health care program faces allegations of overcharging Medicaid, New York AG Eliot Spitzer recently announced.

New York's LTHHCPs provide nursing services, personal care and therapy to Medicaid beneficiaries in their homes. Medicaid uses LTHHCPs' reported costs to set payment rates for each service the LTHHCP provides, Spitzer explains.

The nursing home allegedly reported expenditures for bad debts, advertising and marketing expenses, certain administrative and capital costs, and executive salary and benefit expenses on its cost reports, which improperly inflated its 2001 Medicaid payment rates for personal care services. NY Wants Huge Sum Back From Home The nursing home's bad debts led to Medicaid overpayments of more than $150,000, Spitzer claims. But the AG's lawsuit also includes other overpayments to the nursing home between January 1998 and December 2003 totaling $969,958. The lawsuit seeks repayment, plus interest.

Find it online: To read the news release, go to http://www.oag.state.ny.us/press/2005/sep/sep28b_05.html.