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August 22, 2011

 

DiNapoli: Auditors Stopped $2.3 Million in Medicaid Overpayments

New York State stopped more than $2.3 million in Medicaid overpayments after an audit found errors in the Department of Health's eMedNY computer payment system, according to a report released today by New York State Comptroller Thomas P. DiNapoli. The report is a six-month summary of the comptroller's ongoing audits of payments made to Medicaid providers.

"The state continues to face tough fiscal constraints and we have to be ever vigilant of how taxpayers' money is spent," DiNapoli said. "DOH has to do an even better job stopping overpayments and recouping money that should never have gone out the door."

DOH administers the State's Medicaid program. DOH's eMedNY computer system processes Medicaid claims submitted by providers for services rendered to Medicaid eligible recipients and generates payments to reimburse the providers for their claims. During the six-month period ended September 30, 2010, eMedNY processed 163 million claims worth $24 billion.

In addition to the overpayments, DiNapoli's auditors found 21 providers receiving Medicaid money had been charged with abusing Medicaid, federal Medicare, or other health insurance systems. DOH terminated eight of those providers and was determining the status of the remaining 13 as auditors were ending their fieldwork.

DiNapoli's auditors found:

  • About $1.4 million in overpayments resulting from improper claims from out-of-state hospitals;
  • $635,163 in overpayments for claims that had incorrect Medicare eligibility information or incorrect Medicare reimbursement amounts;
  • $552,827 in overpayments resulting from claims for inpatient stays for high (intensive) levels of care that should have been based on less costly "alternate" levels of care;

DiNapoli's auditors made a series of recommendations calling on DOH to recover Medicaid improper payments and improve the controls over payments in areas covered by the audit. DOH officials generally agreed with the recommendations and indicated they have or plan to implement them.

At the time of the audit, efforts by DiNapoli's auditors had helped recoup about $2.3 million of the almost $2.9 million in overpayments made or scheduled.
A complete copy of the report can be found at: http://www.osc.state.ny.us/audits/allaudits/093011/10s15.pdf

About the State Comptroller's Medicaid Audits
The Office of the State Comptroller conducts regular audits of the state's $50 billion Medicaid program. In the 2010-2011 state fiscal year, auditors identified $936 million in overpayments and audit savings. Auditors review Medicaid claims that have been submitted by service providers and identify billing patterns and other circumstances that warrant an examination to determine whether claims are valid and appropriate.


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