Department of Health

Medicaid Payments for Durable Medical Equipment

If an individual is eligible for both Medicare and Medicaid, the individualís eligible medical costs are generally paid by Medicare. We examined claims paid by Medicaid during 2001 and 2002 for durable medical equipment provided to individuals who were eligible for both Medicaid and Medicare. We found that the equipment providers did not always bill Medicare for Medicare-eligible services. Instead, the providers billed the services to Medicaid and were reimbursed by Medicaid. The Departmentís claims processing system did not prevent these overpayments, because it does not flag claims involving dual eligible recipients for a determination of their Medicare billing status. According to Department officials, overpayments of this kind should be prevented when the new Medicaid claims processing system, eMedNY, is operational.

For a complete copy of Report 2004-S-18 click here.
For a copy of the 90-day response click here.