Briefly Noted

Abstract

A federal audit of opioid treatment programs (OTPs) — methadone clinics — in New York City found that of 115 random sample claims, 35 did not comply with Medicaid requirements, and that of 598 claims in a non‐random sample, 299 were billed in error. Extrapolating these errors, the federal Department of Health and Human Services (HHS) says the state improperly claimed at least $39.3 million in the federal share of Medicaid reimbursement, and owes that money back. Improper claims were mainly due to failure to record patients in the central registry, which exists to make sure patients aren't enrolled in multiple OTPs (18 of the 35 noncompliant claims). This was not an audit alleging fraud. Extrapolation as an accounting method for OTPs, where patients often come in every day, so that each patient has more than 300 claims a year, is questionable, but OTPs are used to this even in state audits. In other words, one OTP patient comes in six days a week, with six claims, and the database balloons. “You're extrapolating over our universe, and our universe becomes large because people come in for medication,” said Allegra Schorr, president of the Coalition of Medication‐Assisted Treatment Providers and Advocates, a New York–based membership organization, and board member of the American Association for the Treatment of Opioid Dependence. “When you're just trying to get money, this counts,” said Schorr. “They hit the lottery when it comes to an audit because of that extrapolation.” However, Schorr, who is also an owner and vice president of West Midtown Medical Group, a Manhattan‐based group that was the first OTP to dispense buprenorphine in New York state, stresses that compliance is always important. “It's critical that there is oversight,” she told ADAW. Meanwhile, the state is reviewing the audit and will respond. “The Office of Addiction Services and Supports (OASAS), in partnership with the NYS Office of Medicaid Inspector General, intends to review the specific findings of this audit cited by OIG [Office of Inspector General] to verify its accuracy and to determine an appropriate course of action,” said Evan Frost, spokesman for OASAS. “As a proactive measure, we will remind our OTP providers of their obligations to comply with state and federal laws and rules for providing and claiming Medicaid reimbursement and ensuring the quality of care for those receiving OTP services.” OA SAS regulates OTPs in the state. For the audit, go to https://oig.hhs.gov/oas/reports/region2/21701021.pdf