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Medicaid Changes. Discussion Points. What? Why? The Federal False Claims Act NYS False Claims Act Speech Therapy Counseling Transportation Financial Impact. What?. Medicaid stopped payments for speech, counseling, and transportation. All pending claims will be denied.
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Discussion Points • What? • Why? • The Federal False Claims Act • NYS False Claims Act • Speech Therapy • Counseling • Transportation • Financial Impact
What? • Medicaid stopped payments for speech, counseling, and transportation. • All pending claims will be denied. • No future payments will be made until State can be sure all services meet new standard. • Applies to all unpaid speech, counseling, and transportation service.
Why? US Attorney “Stop or else”
Federal False Claims Act • ‘‘knowing’’ and ‘‘knowingly’’ acts in deliberate ignorance of the truth or falsity of the information; • acts in reckless disregard of the truth or falsity of the information. • No proof of specific intent to defraud.
Federal False Claims Act 1986 Amendments to false claims act means any person or entity in the process can be liable even if they didn't know the claim was false.
Federal False Claims Act It is immaterial that [United Labs] did not deal directly with the Government. That they were one step removed from direct contact with the [Government] does not vitiate or diminish their liability.
Federal False Claims Act Summary Any school, provider or contractor is liable if it submits or causes to be submitted a false or fraudulent claim or a false statement in support of a claim.
Federal False Claims Act • The fact that your staff or contractor did not know enough to claim correctly is not material. • Not knowing is not a defense.
NYS State False Claims Act • "Local government" ….school district, board of cooperative educational services, …….
NYS State False Claims Act • False claim" means any claim which is, either in whole or part, false or fraudulent • Includes any claim paid out of state aid, local taxes, etc.
NYS State False Claims Act • acts in reckless disregard of the truth or falsity of such claim or information. Proof of specific intent to defraud is not required, provided, however that acts occurring by mistake or as a result of mere negligence are not covered by this article
NYS State False Claims Act • The attorney general shall have the authority to investigate violations • Any person may bring a qui tam civil action for a violation • Provide protection for employee who brings an action.
NYS State False Claims Act • NEW YORK STATE PAYS U.S. $26.97 MILLION TO SETTLE DISPUTE • Denoncourt will receive 15 percent of the United States' recovery, or $4.05 million. • http://www.usdoj.gov/opa/pr/Pre_96/December94/725.txt.html
False Claims Acts Summary • Do not continue to bill the old way. • All documentation must be in hand before a bill is submitted. • Show actual nature, duration and scope of each service. • Provider qualifications must be confirmed. • Provider Certification
Speech Therapy • Services Provided by a “Speech Teacher” must be clinically supervised by a licensed and currently registered speech pathologist. • ASHA Certification OUT!
Speech Supervision Federal standard being applied is their standard for Audiology. • Clinical Supervision. • LSP is responsible. Its their license. • Periodic meetings with child and teacher. • Agreement must show they are the clinical supervisor.
Speech - Summary • LSP are OK, if currently registered. • ASHA out. • Unless supervision was in place you cannot bill for any service before the supervision starts. • Starts with first documented meeting with child.
Counseling Person providing counseling must be licensed and currently registered to practice privately.
Not Covered Counseling • School Counselors, School Psychologists, School Social Workers are not eligible. • Anyone who only holds a certificate from the Office of Teaching Initiatives
Covered Counseling Licensed from the Office of the Professions • Mental Health Practitioners • Creative Arts Therapists • Marriage and Family Therapists • Mental Health Counselors • Psychoanalysts
Covered Counseling • Social Work • Licensed Clinical Social Worker • Licensed Master Social Worker • Psychologist
Covered Counseling Supervision - Unknown
Transportation • Must have logs for all trips regardless of date. • Logs must contain on and off information both ways. • Reduction in speech and counseling billing will impact transportation payments.
Financial Impact • All billing will be delayed at least for the next 60-90 days. • Anticipate delay in payments for balance of school year. • If supervision was not in place, it can’t be.
Financial Impact • Must void all claims discovered as not meeting requirements. • E.G. LSP is not currently registered.
Regulatory and Congressional Actions • Protecting Children's Health in Schools Act of 2007 (Introduced in House) HR 1017 IH • Protecting Children's Health in Schools Act of 2007 (Introduced in Senate) S 578 IS
Regulatory and Congressional Actions • Proposed Regulation • Medicaid Program; Cost Limit for Providers Operated by Units of Government and Provisions To Ensure the Integrity of Federal-State Financial Partnership Source -Federal Register: January 18, 2007 (Volume 72, Number 11)]
