Medicaid Complaint Procedure

  • Any officer, employee, or individual that believes he/she has seen or suspects non-compliant behavior concerning billing, payments, medical necessity of services, quality of services, governance, mandatory reporting, credential or other risk areas shall report such to the Medicaid Compliance Officer through informal or formal means. 

    Upon the receipt of such complaint, the Medicaid Compliance Officer shall notify the Assistant Superintendent who shall determine who shall do the investigation.

    All complaints of non-compliance will be held in confidence to the extent practicable to enable the District to conduct a thorough investigation and as permitted by law.  The District respects the privacy and anonymity of all parties and witnesses to complaints brought under the policy, but it cannot guarantee absolute confidentiality.  At the conclusion of the investigation and at such time when the written report is issued and becomes a final determination (30 days after the issuance of the report if no appeal is made or after the issuance of the appeal determination), the report may become public.

    Upon receipt of any complaint of non-compliance, the designated investigator shall conduct a thorough, prompt and impartial investigation of the charges within 30 calendar days of receipt of the complaint.  All complaints of the non-compliance shall be taken seriously and investigated to the fullest extent possible.  The investigator shall prepare a written report of the investigation.  The report shall be filed with the Superintendent.

    If after investigating the complaint, it is found to have merit, the case will be reported to the Office of the Medicaid Inspector General and any overpayments associated with the non-compliance will be refunded. When a complaint involves allegations which constitute or may constitute criminal behavior, police authorities or the District Attorney's office shall be immediately notified.

    Any problems identified will promptly and thoroughly be corrected.  Policies, procedures and systems will be implemented as necessary to reduce the potential for reoccurrence.

    Any complaint or suspicion shall be communicated to the Medicaid Compliance Officer (Julie Mitrowski) as follows:

    ·  Informally through a conversation

    ·  Formally through a letter

    ·  Through the District anonymous email account:

    Medicaid Complaint Form


    Julie Mitrowski, Medicaid Compliance Office

    Pioneer Central School District

    (716) 492-9309