Department of Health
Department of Social Services

Medicaid Payments for Medicare Beneficiaries

If an individual is covered by both Medicare and Medicaid, the individual's Medicare benefits should be exhausted before any Medicaid payments are made on behalf of the individual. We examined the procedures used by the Department of Health and the Department of Social Services to ensure that such individuals' Medicare benefits are, in fact, exhausted before Medicaid payments are made for inpatient hospital services provided to the individuals. We found that improvements are needed in these procedures, as during 1994 alone, as much as $8.2 million in Medicaid may have been overpaid because such individuals' Medicare benefits were not exhausted before Medicaid payments were made. We recommend that the overpayments be recovered and consideration be given to adopting a type of Medicaid billing system that is used by other states and is designed to prevent such overpayments. We also recommend that New York officials take action to help ensure the use of a certain Medicare benefit; if this benefit had been fully used in 1994, New York's Medicaid payments could have been reduced by at least another $4.2 million.

For a complete copy of Report 95-S-91 click here.
For a copy of the 90-day response click here.