Department of Health
Duplicate Medicaid Payments for Outpatient Services (Follow-Up Report) Medicaid claims are processed and paid by an automated system (eMedNY). The system has various automated controls that are intended to identify, and prevent the payment of, duplicate or otherwise inappropriate claims. However, in audit 2006-S-73, we determined that the controls could not detect certain types of duplicate claims from certain types of medical providers (i.e., providers that treat individuals with developmental disabilities in non-residential settings, provide methadone maintenance treatment, and provide dialysis services). During the five years covered by our audit, we determined that as much as $8.8 million in duplicate payments were made to 718 of these providers. We recommended these potential overpayments be investigated, all overpayments recovered, and controls developed for detecting and preventing such overpayments. When we followed up on these matters with Department of Health officials, we found that they had made some progress in addressing the problems, but still needed to take additional action.
For a complete copy of Report 2009-F-35 click here.
For a copy of the 90-day response click here.