Department of Health
Medicaid Claims Processing Activity: October 1, 2009 through March 31, 2010 Medicaid claims are processed and paid by an automated system (eMedNY) that is overseen by the Department of Health. We performed audit work related to the system and the payments made for the period October 1, 2009 through March 31, 2010. We concluded that eMedNY reasonably ensured that Medicaid claims were submitted by approved providers, were processed in accordance with requirements, and resulted in correct payments to the providers. However, we also identified certain conditions relating to actual and potential overpayments exceeding $6 million. Approximately $4.7 million of these overpayments were either prevented or recovered by the end of our audit work. In addition, we found there were 15 providers who were charged with abusing Medicaid, Medicare or other health insurance systems. The Department had terminated five of these providers but the remaining ten were still under review. We recommended that the Department recover the inappropriate payments, remove certain providers from the Medicaid program, and improve the controls over the payments in these areas.
For a complete copy of Report 2009-S-71 click here.