Department of Health

Medicaid Payments for Selected Clinic Services Covered by Medicare Part B

Medicare is a federal health insurance program for the aged and the disabled; Medicaid is a joint state and federal health insurance program for the needy. If an individual is eligible for both Medicare and Medicaid, the individual's eligible medical costs are paid by Medicare, except for a portion of the costs relating to certain services (called Part B services), which are paid by Medicaid through Medicare crossover claims. We examined the Medicare crossover claims paid by New York State for certain services provided by clinics. We determined that, for the periods covered by our audit (32 months for some types of services and 56 months for other types of services), the clinics were overpaid as much as $10 million in Medicaid because the bills submitted to New York State by the providers were incorrect and the errors were not detected by the State's Medicaid payment system. We recommend that the overpayments be recovered, the providers' billing instructions be clarified, and controls be established for detecting such erroneous billings.

For a complete copy of Report 97-S-43 click here.
For a copy of the associated follow-up report click here.
For a copy of the 90-day response click here.