Department of Corrections and Community Supervision
Payments for Inmate Health Care
Services
Issued: December 5, 2012
Link to full audit report 2010-S-41
Link to 90-day response
Purpose
To determine if the Department paid health care providers the correct rate for only appropriate
and authorized medical services that were actually provided to inmates for the two years ended
March 31, 2010.
Background
The Department is responsible for providing inmates with health care that is consistent with a
level of care that would be received in the community. The Department contracts with outside
health care providers for certain emergency, inpatient, and outpatient services. Such services are
initiated by a referral from facility medical staff. The Department paid approximately $230 million
to outside medical providers for the two years ended March 31, 2010.
Key Findings
- Medical services to inmates were authorized and, with few exceptions, were provided to inmates.
- Medical care providers were not always paid correctly and overpayments resulted. For example, five providers were overpaid $84,500 in connection with 141 sampled claims where hours billed exceeded hours worked.
- The State could save an estimated $20 million annually if the Department billed Medicaid for eligible inmates inpatient care.
Key Recommendations
- Review the providers identified by this audit as overcharging the Department for hourly clinical services, medical procedures, and mileage. Collect overpayments made to those providers.
- Evaluate the feasibility and cost benefit to seek reimbursement from Medicaid or other third party insurance for medical services from outside providers when appropriate.
Other Related Audits/Reports of Interest
Department of Health: Medicaid Claims Processing Activity April 1, 2010 through September 30, 2010 (2010-S-15)
State Government Accountability Contact Information:
Audit Director: Carmen Maldonado
Phone: (212) 417-5200; 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
