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Office of the New York State Comptroller

Taxpayers' Guide to State and Local Audits

Department of Health
Improper Managed Care Payments for Certain Medicaid Recipients (Issued 7/24/12)


Issued: July 24, 2012
Link to full audit report 2010-S-66

Purpose
To determine if the Department of Health (Department) made Medicaid managed care payments for foster and long-term care recipients who were not eligible for managed care programs. The audit covers the period from July 1, 2005 through June 30, 2010.

Background
Many localities use managed care programs to provide Medicaid services. For the five years ending June 30, 2010, the State spent nearly $38 billion for Medicaid managed care services. However, State law specifically precludes certain categories of recipients from participation in managed care programs. These exclusions include children whose medical care is covered under the foster care daily rate program and individuals who receive services in long-term care settings (such as State-operated psychiatric centers and residential treatment facilities).

Key Findings

  • For the five years ended June 30, 2010, Medicaid made $15.6 million in improper managed care payments on behalf of 14,899 recipients who, by State law, were precluded from enrollment in managed care programs.
  • About $14.4 million (of the $15.6 million) in improper payments were attributable to 13,002 recipients with multiple Medicaid identification numbers.
  • The remaining $1.2 million in improper payments related to 1,897 recipients with only one identification number.

Key Recommendations

  • Investigate the $15.6 million in improper Medicaid managed care payments identified in this audit and recover funds, where possible and appropriate.
  • Direct the local districts, particularly the New York City Human Resources Administration to take the steps necessary to prevent the issuance of multiple identification numbers to Medicaid recipients.
  • Strengthen steps to oversee and monitor Medicaid managed care enrollments.

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