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NYS Comptroller

THOMAS P. DiNAPOLI

Taxpayers' Guide to State and Local Audits

Department of Health
Medicaid Claims Processing Activity October 1, 2008 through March 31, 2009
(Follow-Up)


Issued: December 12, 2013
Link to full audit report 2013-F-21
Link to 30-day response

Purpose
To determine the extent of implementation of the eight recommendations included in our initial audit report, Medicaid Claims Processing Activity - October 1, 2008 through March 31, 2009 (2008-S-155).

Background
Our initial audit report, issued December 22, 2009, examined whether the Department's eMedNY System reasonably assured that Medicaid claims were submitted from approved providers, were accurately processed, and resulted in correct provider payments. We identified five reportable conditions. The first reportable condition entailed the identification and prevention of a potential $20.3 million overpayment resulting from a reimbursement rate that was incorrectly updated on a rate file loaded onto the eMedNY System. The remaining four reportable conditions resulted in overpayments of approximately $1.2 million.

Key Finding

  • Department officials have made progress in correcting the problems we identified in the initial report. However, improvements are still needed. Of the eight prior audit recommendations, five recommendations have been implemented and three recommendations have been partially implemented.

Key Recommendation

  • 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 October 1, 2008 – March 31, 2009 (2008-S-155)
Department of Health: Medicaid Claims Processing Activity April 1, 2012 – September 30, 2012 (2012-S-24)


State Government Accountability Contact Information:
Audit Director: John Buyce
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