[NYAPRS Enews] BN: NYS Audit Finds $92M Medicaid Overcharges, DOH Urged to Step up Oversight

[Harvey Rosenthal]

New York State Audits Finds $92 Million in Medicaid Overcharges 

By Henry Goldman Bloomberg News  December 22, 2009

 

New York state has failed to stem the loss of as much as $92 million in
improper Medicaid reimbursements due to overpayments and billing errors,
state Comptroller Thomas DiNapoli said. 

Auditors found that the Health Department paid more than $53 million to
almost 26,000 recipients who had multiple Medicaid identification
numbers, DiNapoli said today. Health officials "are only taking action
to recover $2.4 million" because they can't determine who was overpaid,
he said. 

"Our audits keep finding that the safeguards designed to detect waste,
fraud and abuse have failed over and over again," DiNapoli said in a
statement. "The Department of Health has to start protecting the
taxpayers' money." 

The audits come as Governor David Paterson seeks $150 million in
Medicaid-fraud savings to help close a $3.1 billion deficit. Previously
in 2009, examinations of the state's $45 billion a year Medicaid program
for the poor found $169 million in overpayments and lost savings,
DiNapoli said. 

"Medicaid is a complex program and it's not easy to make it foolproof,"
said Claudia Hutton, a spokeswoman for the state Health Department.
"Ideally, no claim would ever be inappropriately paid and any would be
immediately recouped. The comptroller is not at odds with most of what
we do." 

Auditors found $21.5 million in incorrect or improperly handled claims
through the Health Department's eMedNY processing system, DiNapoli said.
Auditors stopped the department from paying $20.3 million in claims
submitted with the wrong reimbursement rate, which had been mistakenly
changed to $15,151 from $148, the comptroller said. 

Incorrect Claims

Another $1.2 million was incorrectly paid for neonatal claims and
transportation services that weren't medically necessary or weren't
provided, the comptroller said. 

Auditors found an instance where a Medicaid recipient in Poughkeepsie
received taxi service costing about $300 a day for five days a week to
visit her child in a long-term care facility in Albany about 80 miles
away. "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 comptroller's office reported. Representatives of
the department weren't immediately available to comment. 

Another $17.4 million in "improper and potentially inappropriate
payments" included $5.4 million to 10 hospitals that incorrectly claimed
patients had been discharged, when they had actually been transferred to
other hospitals. Hospitals receive higher Medicaid payments when the
patient is discharged, the comptroller said. In one case, a hospital
received $253,000 instead of the $92,000 it should have gotten, auditors
found. 

"By conducting a broader review of these claims, auditors believe DOH
would identify an additional $12 million in improper payments," DiNapoli
said. 

 

 

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