Department of Health

Medicaid Payments for Out-of-State Ambulatory Surgery Services

In New York State’s Medicaid program, an out-of-State provider of ambulatory surgical services should be reimbursed at the same rates as the in-State providers in the community where the patient resides. However, when we examined the payments that were made over a five-year period to a sample of such out-of-State providers, we found that the providers were routinely overpaid, because they were reimbursed at higher rates than the comparable in-State providers. We identified a total of $12.2 million in actual and potential overpayments. We recommended that the Department of Health investigate the potential overpayments, recover all actual overpayments, and develop controls for preventing such overpayments in the future.

For a complete copy of Report 2009-S-29 click here.