Department of Health
Medicaid Payments for Human Immunodeficiency Virus (HIV) Drug Resistance Testing
Human Immunodeficiency Virus (HIV) drug resistance testing is used to establish more effective treatment plans for HIV infected patients who become resistant to medications used to treat the virus. In New York State’s Medicaid program, such testing is reimbursable on a fee-for-service basis up to a maximum of three tests per recipient per year. However, during our five year audit period, we found that this maximum testing threshold was exceeded for a number of Medicaid recipients, and as a result, about $1.27 million in Medicaid overpayments were made. We recommended that the overpayments be recovered and Medicaid claims processing controls be improved to prevent such overpayments in the future.
For a complete copy of Report 2007-S-137 click here.
For a copy of the 30-day response click here.
For a copy of the associated follow-up report click here.