ASBO SOUTHERN TIER CHAPTER October 22, 2014 MEETING
15
ASBO SOUTHERN TIER CHAPTER October 22, 2014 MEETING Medicaid Compliance & Reporting Presented by Joe Kinney and Karen Shoemaker Kinney Management Services, LLC
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ASBO SOUTHERN TIER CHAPTER October 22, 2014 MEETING. Medicaid Compliance & Reporting Presented by Joe Kinney and Karen Shoemaker Kinney Management Services, LLC. A Few Issues No One Talks About. What is Going to Happen to the Final Settlement Payments Pitfalls In Cost Reporting - PowerPoint PPT Presentation
Transcript of ASBO SOUTHERN TIER CHAPTER October 22, 2014 MEETING
ASBO SOUTHERN TIER CHAPTER
October 22, 2014 MEETINGMedicaid Compliance & Reporting
Presented byJoe Kinney and Karen Shoemaker
Kinney Management Services, LLC
What is Going to Happen to the Final Settlement Payments
Pitfalls In Cost Reporting
Who You should be Concerned About
Record Retention
Recap
A Few Issues No One Talks About
Schools are paid a fee for eligible services billed/claimed. These are advances, not final payments.
Throughout the Year Random Moment Time Studies (RMTS) are Conducted for service providers.
Annual Cost report are filed. State accumulates the allowable cost into
one final Medicaid Claim for the Year in question.
Claiming Process
The Claim is filed with the Federal Government.
The Settlement Payment is Calculated◦ Total Allowed Cost (cumulative of all cost reports)◦ Less Advances Already Paid◦ Equals Net settlement Payment from Federal
Government. Depending on the Year the State Keeps All
or Part of the settlement Amount
Claiming Process - Continued
SFY 4/11 through 3/13 – First $100 million (FS) is kept by State
SFY 4/13 – 3/14 and 4/14-3/15 First $100 million each – total $200 million (FS)
SFY 4/15-3/16 and beyond – 86.5% of all settlements (FS) is Kept by State. Schools get an 13.5% of Settlement Payment.
(Note: fund are distributed to schools and counties in proportion to how much they contributed to the total settlement amount.)
Caution◦ If any county or district owes money back as a result of the settlement,
it must be repaid. Repayment is usually done through claims offsets. ◦ If any county or district neglects to file a cost report, all monies must
be repaid for all advances received for that year.
Settlement Payment DistributionSocial Services Law § 368-d
The Cost Report is the Final Claim.
Incorrect cost reporting attaches to all filed claims.
The Federal false Claims act is always in play.
Impact on Compliance
Including costs that are not Medicaid related.◦ Including staff benefit costs in report that are for
more than the eligible staff. Claiming cost for activity that is actually
more than what it is stated to be.◦ Special Transportation when non-IEP children are
also transported on the lift bus. Including the cost of excluded/debarred
parties in cost report – including in indirect cost.
Common Cost Reporting Errors
Including cost where there is no supporting documentation.
◦ Supporting Documentation must be kept for at least 7 years from the final settlement. Even if your district doesn’t receive a settlement payment.
◦ The service documentation must be kept for the same period and perhaps longer under State Education Law.
Common Cost Reporting Errors – Continued
OMIG - does regular audits.
State Comptroller audits with emphasis on revenue maximization.
Federal OIG audit of State with aim to recover funds – this time you will be in it.
Your own employees, contractors, and parents.
Who is Watching You
The Federal False Claims Act makes the last group the most dangerous.
◦ They get paid 15 – 25% or more of the proceeds.
◦ Proceeds are the cumulative total of the statute provides that one who is liable must pay a civil penalty of between $5,500 to $11,000 and treble the amount of the government’s damages.
Who is Watching You – Continued
The knowledge requirement:
◦ A person does not violate the False Claims Act by submitting false claims to the government; to violate the FCA a person must have:
◦ Submitted or caused the submission of a false claim.
◦ Made a false statement or record with knowledge of the falsity.
False Claims Act
The knowledge requirement:◦ In § 3729(b)(1), knowledge of false information is
defined as being (1) actual knowledge, (2) deliberate ignorance of the truth or falsity of the
information, or (3) reckless disregard of the truth or falsity of the
information. Source - http://www.justice.gov/civil/docs_forms/C-FRAUDS_FCA_Primer.pdf
False Claims Act
Not having records for review when requested can be considered a false claim.
Not having complete records and claiming anyway can be considered a false claim.
Record Retention
Claim all the services your District or County is legitimately entitled to.
Keep all service documentation for at least 7 years from the final settlement – or longer.
Include only allowable costs and if you are not sure, ask the State representatives and PCG and get it in writing.
Recap
Contact information
◦ Karen Shoemaker [email protected]
518-371-0176 Ext. 106
◦ Joe [email protected]
518-371-0176 Ext. 101
Questions
