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August 28, 2007

DiNapoli: State Paid Medicaid Claims for
Deceased Patients, Paid for Services Not Provided

The state paid nearly $10 million for home care and transportation services that were likely not provided. In some instances, reimbursement claims listed services for hospitalized or deceased patients, according to two audits examining the period of 2001 through 2006 released today by State Comptroller Thomas P. DiNapoli. These inappropriate payments occurred because the claims processing system designed to detect and prevent these errors failed.

“Providing services to someone who’s been dead for more than a month should raise red flags. These claims should never have been paid,” DiNapoli said. “New York spends billions of taxpayer dollars for Medicaid services. At the very least, we should make sure those dollars are spent on living patients. There’s a systemic problem in the Medicaid claims processing system. There’s too much fraud slipping through the cracks.”

Auditors found eight cases where Medicaid paid for home care services totaling $13,928 after the patients had already died. In one case, a home care provider billed for services more than a month after an individual’s date of death.

The State Department of Health (DOH), which administers the Medicaid program, reimburses for home care services such as feeding, dressing, housekeeping and assistance with other personal tasks that help the recipient live at home. Medicaid also pays for patients to get from their homes to medical providers.

DiNapoli’s audits found that the majority of overpayments for services occurred while the Medicaid recipients were hospitalized, indicating that these providers likely billed for services that were never provided. These inappropriate payments occurred because DOH’s eMedNY claims processing system did not detect and prevent these payments a persistent problem that auditors have identified in several past audits.

Auditors found similar inappropriate payments for transportation services in an audit released in October 2002 because the claims processing system failed to detect them. In that prior audit, auditors reported that Medicaid made duplicate payments for more than $9.7 million for transportation services. According to DOH officials, they have not recovered any of these duplicate payments.

The audit found:

  • One provider billed Medicaid $5,468.40 for around-the-clock home care services for 15 days even though the patient had been hospitalized.
  • One provider was paid $62,070 for questionable services provided by staff. For example, one employee billed 12 hours a day seven days a week for three months. Two other employees said they provided 24 hours of care, seven days a week.
  • Another $17,045 was paid to a provider for services provided by employees who were the Medicaid recipient’s spouse, parent, son, son-in-law, daughter or daughter-in-law, which is not permitted under DOH guidelines.

Auditors recommended that DOH recover the inappropriate payments and implement appropriate changes to the eMedNY system to prevent these overpayments from occurring. In responding to the audit, DOH said that it believed that auditors had overstated some of the overpayments but noted that it was acting on several of the auditors’ recommendations. See the audits for a copy of DOH’s responses.

Click here for a copy 2006-S-77 on Medicaid Payments to Home Care Providers

Click here for a copy of 2006-S-78 on Medicaid Payments to Transportation Providers

Click here for mp3 audio



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