LOWVILLE — Lewis County Attorney Joan E. McNichol told the Corporate Compliance Committee on Tuesday that the state office of the Medicaid inspector general determined the county owes $1,054.75 back to Medicaid.
Public Health has revenues that are being set aside to pay this money back.
In 2013, Mrs. McNichol’s predecessor, Richard J. Graham, disclosed discrepancies in the Medicaid reimbursement files to the inspector general’s office.
Mrs. McNichol said the office can do audits of Medicaid payments, reimbursements and disclosures.
According to the office’s self-disclosure program guide from 2012, it came up with the system of self disclosure as a way to encourage providers to investigate and report matters that involve possible fraud, waste, abuse or inappropriate payment of funds.
The point is to find these issues through self-review, compliance programs or internal controls, according to the guide.
According to Mrs. McNichol, there were seven claims that had late signatures on them, which resulted in over payments by Medicaid.
Mrs. McNichol told the committee it should understand that the inspector general’s office could come back and do an audit for all of 2013.
Jean M. Dryja, Lewis County General Hospital compliance officer, informed the board at the same meeting that the Medicaid recovery audit contractor has requested 18 records this year to study.
In the past, the number of files requested has been close to 80.
The contractor is looking at the diagnostic-related group and still to care level.
The diagnostic-related group is what the hospital bills under. The medical coders review the record and look at what the correct diagnosis is in conjunction with the physician, according to Mrs. Dryja.
There are still outstanding records the contractor requested in 2013 that are at an appeal level, and there is roughly $76,000 still in appeal.
If the hospital does not agree with the recovery audit contractor’s initial review of the records, it will go on to another initial appeal.
Mrs. Dryja said this process can take months.
If the contractor disagrees with the appeal, it can stand by what it found in its review and ask for its money back.
“If we strongly believe we are right or the firm helping us write all of these letters feels that they are right, then we go to an administrative law judge,” Mrs. Dryja said.
She said if it comes down to having to go to an administrative law judge, that process could take a year and a half to two years.