Department of Health
Office of Temporary and Disability Assistance

Accuracy of Medicare Information for Medicaid Recipients

If an individual is eligible for both Medicare and Medicaid, the individual's Medicare coverage should be taken into account before any Medicaid payments are made on behalf of the individual. We examined the adequacy of the procedures used by New York State to ensure that any Medicare coverage is taken into account before Medicaid payments are made. We found that these procedures are not adequate, as we identified 44,542 Medicaid recipients who were covered by Medicare, but whose Medicare coverage was not identified by New York State's Medicaid payment system and therefore could not be taken into account before Medicaid payments were made on behalf of these individuals. As a result, it is likely that some of $20.2 million in Medicaid payments made on behalf of these individuals during our audit period should have been paid by Medicare instead. (The actual amount that should have been paid by Medicare will be determined in a subsequent audit.) We identified a number of reasons why these individuals' Medicare coverage was not identified by New York State's Medicaid payment system (such as faulty automated data processing procedures) and made a number of recommendations aimed at correcting these problems.

For a complete copy of Report 96-S-91 click here.
For a copy of the 90-day response click here.