Department of Health

Medicaid Payments for Medicare Beneficiaries (Follow-Up Review)

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. In our prior audit report 95-S-91, we examined the procedures used in New York State 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 were needed in these procedures, and identified instances in which Medicaid overpaid $3.8 million because Medicare benefits had not been exhausted before the Medicaid payments were made. In our follow-up review, we found that most of these overpayments ($2.8 million) have been recovered, but little progress has been made in improving the procedures for preventing such overpayments.

For a complete copy of Report 2000-F-8 click here.