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July 21, 2009

State Health Department Overpaid For Medicaid Claims

System allowed $335,000 in Overpayments

The Department of Health (DOH) overpaid Medicaid service providers by $335,000 over a six-month period because of weaknesses in the eMedNY computer processing system, according to an audit released today by State Comptroller Thomas P. DiNapoli. The audit was narrowly focused on Medicaid claims processing activity.

“Medicaid is the single most costly program administered by New York State,” DiNapoli said. “The amount of overpayments caused by processing errors is just a small fraction of Medicaid waste, but any overpayment is too much. These are taxpayers dollars, and DOH needs to do all it can to stop these overpayments and recover those dollars.”

DiNapoli’s auditors found that while the eMedNY system generally worked to accurately process claims and provide correct provider payments, problems with the system remain.

For the period of April 1, 2008 through Sept. 30, 2008, auditors found multiple problems, including:

  • $115,522 in overpayments for invalid neonatal inpatient claims;
  • $107, 619 in overpayments for improperly coded orthodontic claims;
  • $96,808 in overpayments for duplicate transportation claims;
  • three providers who had abused the Medicaid program and had not been terminated from the eMedNY system; and
  • inadequate security controls over Medicaid checks stored by Computer Sciences Corp., DOH’s fiscal agent.

DOH officials agreed with DiNapoli’s recommendations to fix those problems and have begun to implement them.

Click here for a copy of the audit.

About the State Comptroller’s Medicaid Audits:
The Office of the State Comptroller conducts regular audits of the state’s $45 billion Medicaid program. In 2009, DiNapoli’s auditors have identified $25.6 million in overpayments and 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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