Audit finds nearly $1 billion in Medicaid errors

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ALBANY, N.Y. (WHEC) — New York State Comptroller Thomas P. DiNapoli released an audit on Tuesday that found nearly $1 billion in Medicaid billing errors.

The audit reveals that the State Department of Health made $965 million in payments to providers and facilities for services ordered, prescribed, referred, and attended by practitioners who were not enrolled in the state’s Medicaid program.

“Medicaid is a critically important program, but its payment system is rife with errors,” DiNapoli said. “My auditors found the system was allowing payments on claims involving providers who were not certified to treat Medicaid patients. This not only costs taxpayers, but also allows providers who should be excluded, and may be unqualified, to treat patients. DOH must improve its efforts to fix the shortcomings with its billing system.”

The state’s Medicaid program provides healthcare services to low-income New York residents or those with special health needs.

According to the Office of the New York State Comptroller, in the state Fiscal Year ending March 31, 2021, New York’s Medicaid program had approximately 7.3 million recipients and Medicaid claim costs totaled $68.1 billion.

Auditors found that eMedNY, the system DOH uses to process claims allowed improper payments for many services and also allowed providers who were no longer actively enrolled in the Medicaid program at the time of the service to allow those improper claims.

$5.8 million of payments were found to have been made for services involving providers who were excluded from participating in Medicaid due to past improper behavior or wrongdoing.

The audit covered the period from January 2015 to December 2019.

New York State Comptroller Thomas P. DiNapoli recommended that the DOH reviews those $965 million in payments for Medicaid claims involving inactive providers, and determine an appropriate course of action.

He also recommended that the DOH make other updates to its guidelines on billing requirements, and prevent improper Medicaid payments for claims that do not report an active provider.

DOH officials generally agreed with most of the audit recommendations and indicated that certain actions have been—and will be taken.

The full audit can be found here, or read below:

DOH Audit by News10NBC on Scribd