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Health Committee Chair Says Medicaid Billing in Non-Health Agencies is Longstanding Problem
Washington, D.C. – Today, Councilmember David Catania (At-Large) said that he supports Mayor Adrian Fenty’s efforts to reign-in Medicaid billing in the city’s Child and Family Services Agency (CFSA) and the District of Columbia Public Schools (DCPS). The newly created Department of Health Care Finance (DHCF) has begun auditing the two agencies and expects that the District could face significant liabilities due to improper billing of Medicaid between 2003 and 2006. Catania said that problems with Medicaid billing by these two agencies is nothing new and that he is encouraged by the willingness of the Mayor to address it.
“I have been concerned about Medicaid billing in agencies outside the Health Committee’s jurisdiction for a long time,” said Catania. “We addressed these problems in the Department of Mental Health (DMH), and I’m pleased that the city is now going to square the accounts of CFSA and DCPS and install a more professional billing system.”
Catania said that he hopes the progress at DMH will help guide reform at other agencies. The problems within DMH were similar to those in CFSA and DCPS, which are not under the Committee’s jurisdiction. They included the absence of proper documentation, duplication of billings, and lack of justification for billing Medicaid and Medicare. After an intense effort to audit DMH’s billings, the District reconciled all old claims with the federal government. The process resulted in a significantly improved claims process at DMH.
Medicaid will account for nearly $1.85 billion in District spending this year – over 20 percent of the entire budget. Each year the city is required to audit its Medicaid claims to ensure they were justified and complete. If the costs are higher than federal payments, the District is eligible for increased revenues. If the costs are lower than what has been claimed, the District must return a share of federal payments received. Between 2003 and 2006 CFSA and DCPS did not audit these accounts. The DHCF, which is conducting the audits, expects significant disallowances when they are complete later this year.
“Medicaid is enormous and the rules are complex,” said Catania. “However, that is no excuse for some of these non-health agencies to use it as an ATM. Instead, they must learn bill properly and limit spending to the appropriated budget.”
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