Department of Health

Duplicate Medicaid Payments for Outpatient Services

New York State’s Medicaid program is administered by the Department of Health. Medicaid claims are processed and paid by an automated system (eMedNY) that is operated by a contractor. The system has various automated controls that are intended to identify, and prevent the payment of, duplicate or otherwise inappropriate claims. However, we determined that the controls could not detect certain types of duplicate claims from certain types of medical providers. These providers treat individuals with developmental disabilities in non-residential settings, provide methadone maintenance treatment, and provide dialysis services. During the five years covered by our audit, we determined that as much as $8.8 million in duplicate payments were made to 718 of these providers. We recommended these potential overpayments be investigated, all overpayments recovered, and controls developed for detecting and preventing such overpayments in the future.

For a complete copy of Report 2006-S-73 click here.
For a copy of the 90-day response click here.
For a copy of the associated follow-up report click here.