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Office of the New York State Comptroller

Taxpayers' Guide to State and Local Audits

Department of Health
Medicaid Payments to Selected Providers for Services to Recipients with Medicare Part C Coverage (Follow-Up) (Issued 9/6/12)


Purpose
To determine the extent of implementation of the five recommendations included in our initial audit report, Medicaid Payments to Selected Providers for Services to Recipients with Medicare Part C Coverage (Report 2010-S-22).

Background
Our initial audit report, which was issued on December 23, 2010, examined whether the Department of Health (Department) established and implemented adequate controls over Medicaid payments to selected providers for recipients who also have medical coverage under the Medicare Part C program. Individuals with Medicare Part C coverage may be responsible for cost-sharing liabilities such as deductibles and coinsurance. These liabilities, however, may be paid by Medicaid if the individual is also enrolled in Medicaid. For the period from January 29, 2007 through March 31, 2010, auditors identified three providers who incorrectly reported recipients' cost-sharing liabilities on Medicaid claims which resulted in $758,000 in actual overpayments and an additional $1.4 million in potential overpayments. This occurred primarily because the Department lacked adequate controls to prevent Medicaid overpayments for excessive charges. Our initial audit report contained recommendations for improving controls relating to the processing of these claims. We also recommended the Department recover improper Medicaid payments. The objective of our follow-up was to assess the extent of implementation, as of June 5, 2012, of the five recommendations included in our initial report.

Key Findings

  • Department officials made some progress in correcting the problems we identified in the initial report. This included the recovery of $279,500. However, further actions are still needed. In particular, the Department must develop controls to prevent Medicaid overpayments resulting from excessive charges, for coinsurance and other recipient cost-sharing liabilities, on claims related to Medicare Part C. Of the five prior audit recommendations, one was implemented, three were partially implemented and one was not 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.

Link to full audit report (2012-F-9)

Link to 30-day response

Other Related Audits/Reports of Interest
Department of Health: Medicaid Payments to Selected Providers for Services to Recipients with Medicare Part C Coverage Report 2010-S-22


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