Department of Health
Excessive Medicaid Payments for Services to Recipients Receiving Medicare Benefits
If an individual is covered by both Medicare and Medicaid, Medicare is the primary payer. Medicaid is the payer of last resort and generally pays a small portion of costs. We examined whether Medicaid was correctly paying provider claims for services to Medicaid recipients who also have health insurance through Medicare. We found that efforts by the Department of Health (Department) have not been proactive and comprehensive enough to prevent excessive Medicaid payments. The absence of sufficient actions has cost taxpayers about $600 million over our four-year audit period. In particular, New York could have saved about $500 million by adopting certain policies that other states follow when paying claims for dual eligible individuals. Also, the Department made about $100 million in Medicaid overpayments as it processed medical claims pertaining to dual eligible individuals. Some of these overpayments persisted even though they were chronicled in prior audit reports and even though Department management pledged to correct deficiencies. Our audit report recommended the Department recover overpayments and correct the specific problems we identified.
For a complete copy of Report 2009-S-64 click here.