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NY comptroller: Audit finds $6.8 million in Medicaid overpayments

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Posted at 10:11 AM, Nov 30, 2016
and last updated 2016-11-30 10:11:31-05

The New York State Comptroller's office released results of an audit, revealing that the state's Medicaid system made $6.8 million in inappropriate payments. 

Of that, $3.5 million came from seperately billed medical services that should have been covered by managed care plans.

$2.4 million of the overpayments were recovered by the end of the audit fieldwork.

"New York’s Medicaid system is vast and complex with plenty of opportunity for waste and abuse," said Thomas DiNapoli, NY State Comptroller. “My auditors found several cases in which the Department of Health’s eMedNY system failed to catch millions in overpayments. To its credit, the department is working to recoup these overpayments and make adjustments to its processing systems to prevent these problems from reoccurring.” 

The comptroller's office audits Medicaid payments on a routine basis to ensure claims are being paid appropriately and whether or not money should be recovered because of errors. The office found overpayments for more than 14,000 fee-for-service clinic claims that were inappropriate.

DiNapoli’s auditors also found:
·        $1,342,307 in overpayments for claims billed with incorrect information pertaining to other health insurance coverage that recipients had;
·        $937,424 in overpayments for newborn claims that were submitted with incorrect birth weights;
·        $389,813 in improper payments for inpatient, clinic, durable medical equipment, transportation, and eye care services;
·        $333,504 in improper payments identified by the Centers for Medicare & Medicaid Services that DOH did not recover from providers;
·        $260,330 in overpayments for inpatient claims that were billed at a higher level of care than what was actually provided; and
·        $50,767 in improper payments for duplicate billings. 

Auditors also found 15 Medicaid providers who were charged, or guilty of crimes that violated laws or regulations of a health care program; three who were involved in civil settlements. The Department of Health terminated 14 of those offending agencies from the Medicaid program.

You can find the full report here.