DiNapoli: Millions Leaking From Medicaid

New York State Comptroller Thomas P. DiNapoli today called on the state Department of Health (DOH) to increase scrutiny of Medicaid payments and recover any improperly made payments after his auditors identified as much as $92 million in overpayments, billing errors and other problems, according to a press release from his office. The findings of the audits were referred to the Office of the Medicaid Inspector General.

DiNapoli released three audits today examining New York’s Medicaid program.

The first audit found $53 million in improper payments for 25,950 Medicaid recipients who were assigned more than one identification number from local social services districts. DOH made separate Medicaid payments under each identification number to providers. DOH is taking steps to recover duplicate premium payments to single managed care plans totaling $2.4 million. However, it is DOH’s policy not to investigate or recover premium overpayments when two or more Medicaid providers are paid for the same recipient with multiple identification numbers. DOH officials said they could not readily determine which provider to recover payments from.

The second audit found $21.5 million in claims that were either not correct or not properly processed in DOH’s claims processing system called eMedNY. Auditors identified and prevented $20.3 million in claims from being paid out because of an incorrect reimbursement rate in the system. The rate was changed from $147.74 to $15,151.28 and was not detected by eMedNY.

Another $1.2 million was paid out primarily for incorrect neonatal claims and transportation services that were either not medically necessary or not provided. Auditors also found an instance where a Medicaid recipient living in Poughkeepsie, NY received taxi service at a cost of approximately $300 per day for five days a week to visit her child living in a long-term care facility in Albany, NY.

While there was no medical reason for these trips, the Dutchess County Local Department of Social Services approved the trips totaling nearly $196,000.

The final audit found $17.4 million in improper and potentially inappropriate payments, including $5.4 million in overpayments to ten hospitals for incorrectly billing a patient that had been discharged from the hospital rather than transferred to another hospital. Hospitals receive higher payments from the Medicaid program if a patient is discharged.

In one example found, a patient was admitted to a hospital for 18 days for injuries sustained in an accident and was later transferred to another hospital. However, the hospital claimed he was discharged and was paid $253,000 for his treatment rather than the $92,000 it should have been paid. By conducting a broader review of these claims, auditors believe DOH would identify an additional $12 million in improper payments due to these types of errors and abuse.