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February 13, 2020

New York State Allegedly Claimed $39 Million in Improper Medicaid Reimbursements for Opioid Treatment Programs

According to an audit conducted by HHS OIG, the State of New York improperly claimed and received over $39.3 million in Medicaid reimbursements for opioid treatment program (“OTP”) services.  According to the report, OTP’s provide medication-assisted treatment, counseling, and behavioral therapies for people diagnosed with opioid use disorder.  However, based on a sampling of 150 of the 10.7 million Medicaid claims submitted for OTP services in the New York City metropolitan area from 2014 through 2017, the report concluded that 35 of the claims were improper because providers either failed to maintain or provide necessary documentation, did not ensure that the services were consistent with the beneficiaries’ treatment plans, or did not obtain the necessary signatures for such services.  Extrapolating from the 35 non-compliant claims, the audit report recommends that New York State refund $39.3 million to the federal government and take measures to ensure provider compliance with the requirements relating to OTP services.