Department of Health

Monitoring Nursing Home Compliance with Medicaid Participation Requirements and Controlling Provider Payments

The Department of Health supervises and certifies nursing homes in New York State. We examined Department procedures for (1) following up on complaints made against nursing homes, (2) certifying nursing home compliance with federal quality assurance standards, and (3) ensuring that nursing homes are not overpaid Medicaid for certain services provided to patients. We found that the results of certification reviews could be better documented and improvements could be made in the procedures for following up on problems identified during the reviews. We also found that complaints were not always effectively investigated by the New York City regional office. We further found that, during our three-year audit period, nursing homes were overpaid as much as $1.3 million in Medicaid because services covered by the basic Medicaid reimbursement rate were also reimbursed separately. We recommend that the overpayments be recovered and procedures be established for preventing such overpayments in the future.

For a complete copy of Report 97-S-30 click here.
For a copy of the associated follow-up report click here.
For a copy of the 90-day response click here.