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State Auditor Issues $45,000 in Medicaid Findings for Recovery
Columbus - Incomplete or missing documentation of medical evaluations resulted in more than $45,000 in findings for recovery in a Medicaid audit released today. The Ashtabula location of Lincare, Inc., a national supplier of durable medical equipment operating throughout Ohio, was found to owe the Ohio Department of Job and Family Services $45,269.53 in Medicaid reimbursements, including interest.
The findings result from non-compliance with Medicaid reimbursement rules for oxygen services. Oxygen services require physician approval by means of certificates of medical necessity, similar to prescriptions. The audit found Lincare provided incomplete or missing certificates and failed to document medical evaluation of patients prior to the prescription of oxygen services.
“Doctors are busy, providers are busy and patients are busy, but you can’t cash a check before you write it,” Yost said. “Proper documentation is essential both to patient health and taxpayer value. These certificates are there to ensure that services are appropriate and that reasonable procedures are in place.”
The audit reviewed Medicaid reimbursements filed by Lincare from Nov. 1, 2007 to Oct. 29, 2009. During this time, the provider was reimbursed $156,418.57 for 1,345 services. Recoverable findings were calculated at $40,590.00, with accrued interest in the amount of $4,679.53.
Although no finding was issued for a separate material reportable condition, the audit also found ambiguities in plans of treatment for patients, concluding that the plans were not based on individual patient needs. The plans failed to specify whether qualifying diagnostic tests were to be performed at rest, during sleep or during exercise, as required by regulation, and also resulted in Lincare making determinations about tests and testing conditions instead of the prescribing physician.
The Auditor of State’s office, one of five independently elected offices in Ohio, is responsible for auditing more than 5,600 state and local government agencies. Under the direction of Auditor Dave Yost, the office also provides financial services to local governments, investigates and prevents fraud in public agencies and promotes transparency in government.