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Immediately
December 10, 2007

 

DiNapoli: State Medicaid Overpaid Health Care
Providers More Than $4 Million

Home Health Care Providers Were Paid for Patients Not in Their Care
and Medicaid Paid for Lab Services Twice

The state paid home health care providers $2.09 million for Medicaid claims even though their patients were not in their care but residing in nursing homes. The state also made $2.9 million in Medicaid payments to outpatient and laboratory service providers who should have gotten paid by the hospital or substance abuse facility who ordered the services, according to two audits released today by State Comptroller Thomas P. DiNapoli.

“Medicaid costs are already high. The last thing the state needs to do is pay for services not rendered or pay for the same service twice,” said DiNapoli. “The state should take the steps necessary to recoup these costs. The Department of Health (DOH) has to improve their controls and verify the legitimacy of payments before they are made.”

The audit of home health care services covered a five-year period ending September 2006. The audit regarding outpatient and laboratory services covered a five-year period, ending February 2007. Auditors found that many overpayments occurred because:

  • providers either ignored or misinterpreted Medicaid billing guidelines;
  • the state’s Medicaid claims processing system, eMedNY, isn’t designed to prevent or detect these kinds of overpayments; and
  • the audit routines used by the Office of the Medicaid Inspector General (OMIG) to detect these overpayments is not as thorough as they could be.

DiNapoli recommended that:

  • DOH review the overpayments and recover them from the service providers;
  • DOH establish a system that will better monitor and prevent the overpayments;
  • DOH ensure that providers understand the billing guidelines;
  • OMIG re-evaluate its claims monitoring process with an eye toward improving it; and
  • DOH work with Office of Alcohol and Substance Abuse Services (OASAS) officials to ensure that providers are not paid twice for these services.

Officials generally agreed with the audits’ findings and indicated they will take corrective action.

 

Click here for the audit report regarding inappropriate payments to home health care providers.

Click here for the report regarding payments to outpatient and laboratory services.

 

About the State Comptroller’s Medicaid Oversight
The Office of the State Comptroller conducts regular audits of the state’s $47 billion Medicaid program, identifying hundreds of millions of overpayments and fraud. 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. In 2007 alone, the State Comptroller’s Office identified more than $42 million in potential overpayments or inappropriate claims paid by the state’s Medicaid program.

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