FWA- NY Comptroller audit reveals months totaling billions in improper Medicaid payments


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[MM Curator Summary]: Auditor finds millions in waste, again. State officials say “don’t worry we have it handled,” again.


Clipped from: https://cbs6albany.com/news/you-paid-for-it/ny-comptroller-audit-reveals-months-totaling-billions-in-improper-medicaid-payments-s-third-party-health-insurance-ny-doh-department-of-health-dinapoli



New York State Comptroller Thomas DiNapoli has released an audit of the Department of Health’s Medicaid claims processing program that he says identified more than $22 million in improper Medicaid payments from October of 2021 through March of 2022.

Among the findings from the comptroller, $11.5 million was paid for managed care premiums on behalf of Medicaid recipients who also had concurrent comprehensive third-party health insurance.

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$8.9 million was paid for clinic, practitioner, inpatient, managed care and laboratory claims that did not comply with Medicaid policies, such as billing in excess of permitted limits.

In response, the Department of Health said the Office of the Medicaid Inspector General continuously performs audits of Medicaid payments, and the DOH says it will continue to work to recover overpayments as appropriate.

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As a result of the audit, about $9.9 million of the improper payments had been recovered by the end of the audit fieldwork.

During the six-month period in question, the DOH processed more than 294 million claims, resulting in payments to providers of nearly $42 billion.