Department of Health

Medicaid Claims Processing Activity

The Medicaid Management Information System (MMIS) is a centralized, automated medical assistance information and payment system that is operated by a fiscal agent under a contract with the Department of Health. The State Comptroller maintains audit staff on site to conduct continuous audits of the MMIS, including weekly examinations of the accuracy of the Medicaid claims that are processed. During the year ended March 31, 2005, these weekly examinations found that health care providers were overpaid as much as $34.0 million. These overpayments were made because third-party insurance coverage was not taken into account and claim forms were incorrectly completed by providers.

For a complete copy of Report 2004-S-29 click here.
For a copy of the 90-day response click here.