ISSUE
The Illinois Department of Human Services, Division of Developmental Disabilities (IDHS/DDD) seeks to ensure that all billings for Developmental Training (DT) services are accurate, justified and are only provided by authorized licensed providers.
BASIS FOR REVIEW
The ILDHS/DDD must conduct ongoing annual reviews of Medicaid Waiver programs per the approved Medicaid Waiver Application.
METHOD OF REVIEW
The Bureau of Program Development & Medicaid Administration (BPDMA) within the Division of Developmental Disabilities will review billings for an individual that has greater than 8.5 hours billed on a single day between July 1 and December 31. This data is obtained from Mobius Report #M044K201 which reports on the first 2 quarters of the Fiscal Year. BPDMA staff will notify those providers in writing requesting documentation to substantiate their billings.
FINDINGS
The review found that 67% of the billings identified as greater than 8.5 hours were justified, documented and billed correctly while 33% were not justified. The reasons identified for the unjustified billings were some DT providers were not retaining acceptable attendance records, some billed for transportation and lunch that were not authorized in the Individual Service Plan, others identified systemic issues that affected billings and lastly some simply had data entry errors. Attached is a table that breaks down the data gathered during this review.
ACTIONS TAKEN
Providers were asked to back out the erroneous billings, and monies that were paid out for those erroneous bills were recouped. The Division required two providers to submit Corrective Action Plans to ensure they would put plans in place to comply with audit requirements in the future.
Service Dates Included in the Review:
July 1, 2015 to December 31, 2015
Total number of individuals with DT billings during this Timeframe:
17914
Total number of providers found to have billings greater than 8.5 hours:
30
Total dates billed greater than 8.5 hours:
578
Of the 578 dates billed greater than 8.5 hours - 390 were justified billings and 188 were unjustified billings. Below is a breakdown of the unjustified billings.
| Unjustified Billings |
Number of Billings |
Total Providers Involved |
| Billed for Lunch/Travel |
35 |
4 |
| Billing Entry Error |
44 |
9 |
| Systemic Billing Issue |
56 |
3 |
| No Attendance Record on File |
53 |
3 |
| Corrected Billings |
188 |
13 |
Total money recouped from corrections: $13,796.00
