Medicaid Waste - VNR



What happens when the State treats our tax dollars like play money? 

You get the sort of waste that New York State Comptroller Thomas P. DiNapoli found when his office audited the State’s Medicaid program. 

(Comptroller DiNapoli at press conference)
“It probably comes as no surprise that our auditors found that New York State made excessive and unnecessary payments that we estimate could be as much as a hundred and fifty million dollars, because of pervasive problems with its billing system and outdated reimbursement formulas.” 

(narrator)
According to the audits, the problems are substantial. 

Problems like paying an Ohio hospital one-point-five million dollars for service that should have cost only a hundred and seventeen thousand dollars.

Or shelling out three-hundred and sixteen thousand dollars for a procedure that in New York would only be billed at forty-four hundred dollars.

Time after time, out-of-state hospitals cashed in on routine medical procedures – and you paid for it. 

(Comptroller DiNapoli at press conference)

“There is no ‘Free Parking’ jackpot to bail this program out. The waste and abuse in this program is costing taxpayers too much money.”  

(narrator)
But the trouble isn’t just with out-of-state providers.

The Comptroller’s office also found 74-point-5 million dollars in payments to New York hospitals that were not billed correctly. 

For example: if a patient is readmitted for the same ailment within 31 days, it should be to be filed under one claim. The Comptroller’s audit found that not following this policy cost New Yorkers 53 million dollars.

(Comptroller DiNapoli at press conference)
“Too often, New York's Medicaid system treats tax dollars like Monopoly money. There's too much easy come, easy go allowed in the program.”  

(narrator)
To save New York money on Medicaid, the Comptroller made these recommendations:

-Take appropriate action to recover overpayments – and continue to track down cases of excessive reimbursement.

-Strictly follow the rules on reimbursement to avoid overpaying for service. 

-Evaluate the policy for readmissions.

-Require prior approval for services rendered by out-of-state healthcare providers.

New York’s Medicaid program is gigantic. More than 374 million claims are processed annually – representing 48-point-5 billion dollars in payments. That’s why we need careful oversight.

(Comptroller DiNapoli at press conference)
“The Department of Health must take steps to recover this money, and make real changes to stop this waste.”  

“These three audits build on past audits we've had that indicate that there are significant problems with how the Medicaid program is handling its billing, and certainly, this should be another urgent reminder that it's time to update the system and implement more effective policies.”