The Office of the State Comptroller, Medicaid Fraud Division (OSC), conducted this review to identify adult medical day care (AMDC) providers who improperly billed the Medicaid program for duplicative services or who billed for services that exceeded the amount the program permits to be billed. AMDCs are facilities that provide ambulatory care services to adults who require assistance with activities of daily living, including bathing, mobility, and eating. These medically necessary services enable individuals to continue living in a community setting. Through this review, OSC identified 21 AMDCs that violated Medicaid regulations by (1) impermissibly billing for more than five days in a week; (2) billing for services to a beneficiary while that beneficiary was actually in an inpatient facility such as a hospital; and (3) billing for services provided to a beneficiary when in fact another AMDC also billed for the same services to the same beneficiary on the same date. As a result of this review, OSC identified approximately $946,087 in improperly spent Medicaid funds, and thus far, has recovered $839,000 of that amount.
