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September 10, 2010

DiNapoli: DOH Needs To Do More To Collect Medicaid Overpayments

The state Department of Health (DOH) needs to act faster and more effectively to collect approximately $37 million in overpayments owed the state by Medicaid providers, according to an audit released today by New York State Comptroller Thomas P. DiNapoli.

“DOH has done a fairly good job recouping overpayments from Medicaid providers,” DiNapoli said.  “But fairly good is not good enough. State agencies need to do everything they can to protect taxpayer dollars. The state is in a very precarious financial situation. We can’t let millions in overpayments go uncollected.”

DiNapoli’s auditors found DOH could have acted more effectively to collect overpayments from inactive providers, providers who joined group practices and providers who were affiliated and shared the same federal taxpayer identification number.

As of October 1, 2009 the Department was owed about $35 million from inactive providers. A total of 120 of these providers owed about $20 million for at least two years. Another 22 providers owed $3.9 million for six years. While DOH relies on eMedNY to collect accounts receivable out of payments made to providers, inactive providers no longer obtain eMedNY payments. DOH had not made much progress using other methods to collect money from such providers.

DiNapoli’s auditors also found DOH was not using its regulatory authority to recover the $737,469 owed to the state by 1,104 providers who joined group practices. For example, DOH made $12,930 in Medicaid payments to a dentist working in a group practice when the same dentist owed the state $31,537 from when he worked alone.

DiNapoli’s auditors also found DOH did not collect $1.7 million owed by 15 providers who were affiliated with each other and used a common federal tax identification number.

Auditors recommended DOH:

  • Determine the feasibility of options for pursuing the collection of accounts receivable due from inactive providers.
  • Follow regulations and seek recovery of accounts receivable that were owed by providers when they joined a group practice.
  • Ensure procedures and practices address the recovery of all accounts receivables identified through audits or retroactive rate adjustments for affiliated providers.
  • Act in a timely manner to routinely refer appropriate accounts receivable to the State Attorney General for collection.

DOH officials generally agreed with the audit’s recommendations and indicated they have already taken steps to collect the Medicaid money owed to the state.

A copy of the full audit, including the DOH’s response, can be found here:

About the State Comptroller’s Medicaid Audits
The Office of the State Comptroller conducts regular audits of the state’s $50 billion Medicaid program. Auditors review Medicaid claims 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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