Department of Health
Medicaid Claims Processing Activity
for April 1, 2009 through September 30, 2009
(Follow-Up)
Issued: September 26, 2012
Link to full audit report 2012-F-8
Link to 30-day response
Purpose
To determine the extent of implementation of the 11 recommendations included in our initial audit report, Medicaid Claims Processing Activity April 1, 2009 through September 30, 2009 (Report 2009-S-21).
Background
Our initial audit report, which was issued on September 23, 2010, examined whether the Department’s eMedNY system reasonably ensured that Medicaid claims were submitted by approved providers, were processed in accordance with requirements, and resulted in correct payments to the providers. For the six-month period ended September 30, 2009, we concluded that, overall, the eMedNY system 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 the need for improvements in the processing of certain types of claims that caused about $4.5 million in overpayments, including: those from certain providers of vision-related services; a claim for an 11-year inpatient stay; those from a hospital that provides hemophilia treatment services; neonatal claims with errant birth weight data; and several that were Medicare-related. Our initial audit report contained recommendations for the Department to recover inappropriate payments, remove certain providers from the Medicaid program, and improve the controls over the payments in these areas. The objective of our follow-up was to assess the extent of implementation, as of June 30, 2012, of the 11 recommendations included in our initial report.
Key Findings
- Department officials made some progress in addressing the problems we identified in the initial audit. However, further actions are still warranted. Of the eleven prior audit recommendations, six were implemented, and five were partially implemented.
Key Recommendations
- Officials are given 30 days after the issuance of the follow-up review to provide information on any actions that are planned to address the unresolved issues discussed in this review.
Other Related Audits/Reports of Interest
Department of Health: Medicaid Claims Processing Activity April 1, 2009 through September 30, 2009 Report 2009-S-21
Department of Health: Medicaid Claims Processing Activity October 1, 2010 through March 31, 2011 Report 2010-S-65
Department of Health: Medicaid Claims Processing Activity April 1, 2010 through September 30, 2010 Report 2010-S-15
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
