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Office of the New York State Comptroller

Taxpayers' Guide to State and Local Audits

Department of Health
Overpayments for Hospital Readmissions (Follow-Up) (Issued 10/26/12)


Purpose
To determine the extent of implementation of the five recommendations included in our initial audit report, Medicaid Overpayments for Hospital Readmissions (2009-S-28).

Background
Our initial audit report, which was issued on May 3, 2010, examined whether the Department of Health (Department) overpaid hospitals when the hospitals readmitted patients they had recently discharged. During the audit period, January 1, 2004 through June 30, 2009, our audit identified overpayments totaling nearly $163,000 from a review of a judgmental sample of claims from five hospitals. These hospitals have already refunded the overpayments to Medicaid. The audit also identified four other hospitals with questionable claims. We recommended the Department review these claims to verify whether overpayments were made and recover overpayments when appropriate. We also recommended the Department remind hospitals of their responsibility for combining admission and readmission claims and that the Department evaluate the need for stricter readmission policies.

Key Findings

  • Department officials have made progress in correcting the problems we identified in the initial report.  Of the five prior audit recommendations, three have been implemented, has been partially implemented, and one is no longer applicable.

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-11)

Link to 30-day response

Other Related Audits/Reports of Interest
Department of Health – Medicaid Overpayments for Hospital Readmissions Report 2009-S-28


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