Department of Health

Multiple Medicaid Payments for Managed Care Recipients

Many of New York’s Medicaid recipients are enrolled in managed care plans. If a recipient is enrolled in such a plan, the plan pays for the medical services provided to the recipient, and Medicaid pays the plan a fixed monthly capitation premium for each recipient enrolled in the plan. If a Medicaid recipient is mistakenly assigned more than one Medicaid identification number, the State may pay the recipient’s managed care plan more than one monthly capitation premium. We estimated that, during our four-year audit period, at least $45 million in duplicate premium payments had been made for such recipients. While the Department of Health had taken actions to address this problem, we determined that the actions were not sufficient and recommended certain additional actions be taken.

For a complete copy of Report 2004-S-48 click here.
For a copy of the 90-day response click here.
For a copy of the associated follow-up report click here.