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NYS Comptroller

THOMAS P. DiNAPOLI

Taxpayers' Guide to State and Local Audits

Department of Health
Medicaid Payments for Medicare Part A Beneficiaries (Follow-Up)


Issued: April 04, 1024
Link to full audit report 2013-F-16
Link to 30-day response

Purpose
To determine the extent of implementation of the four recommendations made in our audit report, Medicaid Payments for Medicare Part A Beneficiaries (2009-S-36).

Background
Our initial audit report, which was issued on September 20, 2010, examined whether Medicaid made overpayments for recipients who were also enrolled in Medicare Part A. Medicare Part A provides supplementary medical insurance for inpatient care in hospitals, post-hospital nursing home care, hospice and home health services. If an individual is enrolled in both Medicaid and Medicare (commonly referred to as "dual-eligible"), Medicare is the primary payer and generally covers most of the eligible costs for health services. Medicaid, as a secondary payer, generally pays a small portion of the costs, such as coinsurance or deductibles.

For the two years ended December 31, 2007, our audit identified $14 million in potential Medicaid overpayments for claims pertaining to 2,564 dual-eligible individuals. We recommended that the Department of Health improve their detection of Medicare Part A coverage for Medicaid recipients and prevent improper payments.

Key Finding

  • Officials made considerable progress in correcting the problems we identified in the initial audit report. This included the recovery of approximately $22.6 million in Medicaid overpayments for services provided to recipients who were also covered by Medicare Part A. Of the initial report’s four recommendations, three were implemented and one was not implemented.

Key Recommendation

  • Officials are given 30 days after the issuance of the follow-up report to provide information on any actions that are planned to address the unresolved issues discussed in this report.

Other Related Audits/Reports of Interest

Department of Health: Medicaid Payments for Medicare Part A Beneficiaries (2009-S-36)


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