New York Audit Uncovers Millions of Dollars in Medicaid Overpayments

In a press release issued August 22, 2011, New York State Comptroller, Thomas DiNapoli, announced that New York State stopped or recovered more than $2.3 million in Medicaid overpayments after an audit of the Department of Health’s eMedNY computer payment system.
The Comptroller’s Office oversees the financial affairs of New York state agencies, public authorities and local government agencies. Their most recent audit of the eMedNY computer payment system covered the six-month period beginning April 1, 2010 and ending September 30, 2010.
During the audited period, eMedNY processed approximately 163 million claims resulting in payments to providers of about $24 billion. The claims were processed and reimbursed in weekly cycles which averaged about 6.2 million claims and $931 million in Medicaid payments to the providers.
Although the conclusion of the audit was that eMedNY reasonably ensured Medicaid claims were submitted by approved providers, were processed according to requirements, and resulted in correct payments to providers, the audit did identify actual and potential overpayments totaling almost $2.9 million. The overpayments identified included the following:
• about $1.4 million in overpayments resulting from improper claims from out-of-state hospitals;
• about $600,000 in overpayments for claims that had incorrect Medicare eligibility information or incorrect Medicare reimbursement amounts;
• about $550,000 in overpayments resulting from claims for inpatient stays for high levels of care that should have been based on less costly levels of care • about $200,000 in overpayments resulting from neonatal inpatient claims that included incorrect claim information;
• about $56,000 in overpayments for vision care claims; and • about $5,000 in overpayments due to forged prescriptions and billings for refills that were not provided to recipients.
At the time the audit was completed, approximately $2.3 million of the $2.9 million in actual and potential overpayments had been stopped or recovered by the Comptroller’s Office.
In addition to the overpayments, the Comptroller’s Office also advised the Department of Health of 21 providers who had been charged with abusing Medicaid, federal Medicare, or other health insurance systems. Eight of the 21 providers identified had already been terminated from the program by the Department of Health, however, the statuses of the remaining 13 providers identified in the audit were still under review when the audit concluded. Six of the 13 providers identified by the Comptroller’s office had received approximately $200,000 in Medicaid payments since the beginning of the audit period.

For more information regarding Medicare and Medicaid programs please contact The Health Law Partners, P.C. at (212) 734-0128 or (248) 996-8510. For more information on Medicare or Medicaid audits please contact Abby Pendleton, Esq. or Jessica L. Gustafson, Esq. at (212) 734-0128 or (248) 996-8510. More information may also be obtained at the HLP website.