Department of Health

Accuracy of Medicare Information for Medicaid Recipients (Follow-Up Review)

If an individual is eligible for both Medicare and Medicaid, the individual's Medicare coverage should be taken into account before any Medicaid payments are made on behalf of the individual. In our prior audit report 96-S-91, we examined the adequacy of the procedures used by New York State to ensure that any Medicare coverage is taken into account before Medicaid payments are made. We found that these procedures were not adequate, as we identified 44,542 Medicaid recipients who were covered by Medicare, but whose Medicare coverage was not identified by New York State's Medicaid payment system and therefore could not be taken into account before Medicaid payments were made on behalf of these individuals. As a result, it was likely that some of $20.2 million in Medicaid payments made on behalf of these individuals during our audit period should have been paid by Medicare instead. We identified a number of reasons why these individuals' Medicare coverage was not identified and made several recommendations aimed at correcting these problems. In our follow-up review, we found that most of these recommendations have been implemented, and as a result of the improvements made by the Department of Health in identifying Medicaid recipients' Medicare coverage, about $16.3 million in Medicaid payments were recovered by New York State.

For a complete copy of Report 99-F-53 click here.
For a copy of the 90-day response click here.