Department of Health

Medicaid Payments for Selected Clinic Services Covered by Medicare Part B (Follow-Up Review)

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. In our prior audit report 97-S-43, we examined the Medicare crossover claims paid by New York State for certain services provided by clinics and determined that the clinics were overpaid as much as $10 million in Medicaid because the bills submitted to New York State were incorrect and the errors were not detected by the State's Medicaid payment system. We recommended that the overpayments be recovered, the billing instructions be clarified, and controls be established for detecting such erroneous billings. In our follow-up review, we found that progress has been made by Department officials in implementing these recommendations, and because certain recommendations were implemented, an additional $13 million in overpayments were identified by the Department since the completion of our prior audit.

For a complete copy of Report 99-F-18 click here.