Department of Health
Inappropriate Medicaid Payments
for Recipients with Multiple
Identification Numbers and
Social Security Numbers (Issued 7/24/12)
To determine whether the Department of Health (Department) ensures local social services districts properly assign identification numbers to individuals eligible for Medicaid and if inappropriate Medicaid payments were made as a result of Medicaid recipients being assigned multiple identification numbers. The audit covers the period June 2007 - May 2010.
The Department oversees and establishes guidelines for local social services districts (local districts) regarding Medicaid eligibility. Local districts are solely responsible for determining whether individuals applying for Medicaid meet eligibility requirements, and they are also responsible for assigning eligible Medicaid recipients unique identification numbers. The recipient identification number is a critical factor in determining the appropriateness of Medicaid payments. In prior audits, we identified significant overpayments because recipients were issued multiple Medicaid identification numbers.
- For the three years ended May 31, 2010, the Department overpaid about $17.3 million in Medicaid because 9,848 recipients were enrolled into Medicaid with multiple identification numbers. The problem of multiple identification numbers and related overpayments is longstanding. Though the Department has taken steps to address it, still more needs to be done.
- Several circumstances led to the assignment of multiple Medicaid identification numbers. For example, the State's Welfare Management System (WMS) produces reports identifying persons who are already enrolled in Medicaid. However, the reports are not useful in checking for a duplicate recipient identification number when a social security number is not recorded in connection with an already established identification number. In addition, the WMS provides online tools that can help local social service districts identify people who are already enrolled in Medicaid in another locality even when the person seeking enrollment does not provide a social security number. However, local social service personnel were often not aware that these tools could be used in these situations.
- Take steps to minimize the potential for the issuance of multiple identification numbers to the same recipient. This includes improving the utility of pertinent WMS reports and advising local social service personnel of useful WMS tools.
- Investigate the $17.3 million in overpayments and recover when appropriate.
Other Related Audits/Reports of Interest
Department of Health: Improper Medicaid Payments for Recipients with Multiple Identification
Numbers Report 2008-S-163
Department of Health: Multiple Medicaid Payments for Managed Care Recipients Report 2004-S-48
State Government Accountability Contact Information:
Audit Director: Brian Mason
Phone:(518) 474-3271; Email: StateGovernmentAccountability@osc.state.ny.us
Address: Office of the State Comptroller; Division of State Government Accountability; 110 State Street, 11th Floor; Albany, NY 12236