Department of Health

Multiple Medicaid Payments for Managed Care Recipients (Follow-Up Report)

Many of New York Stateís Medicaid recipients are enrolled in managed care plans. If a recipient is enrolled in such a plan, the plan pays for the medical services provided to the recipient, and Medicaid pays the plan a fixed monthly capitation premium for each recipient. If a Medicaid recipient is mistakenly assigned more than one Medicaid identification number, the State may pay the recipientís managed care plan more than one monthly capitation premium. In audit report 2004-S-48, we found that at least $45 million in duplicate premium payments were made over a four-year period because recipients were assigned more than one identification number. We recommended that certain actions be taken by the Department of Health, and when we followed up on these matters with Department officials, we found that our recommendations had been implemented.

For a complete copy of Report 2007-F-6 click here.
For a copy of the 90-day response click here.