Department of Health

Medicaid Claims Processing for the Six Months Ended September 30, 2005 (Follow-Up Report)

New York State’s Medicaid program is administered by the Department of Health. Medicaid claims are processed and paid by an automated system that is operated by a contractor. On March 24, 2005, a new automated system (eMedNY) became operational. In audit report 2005-S-31, we examined selected claims processed by this system during the six months ended September 30, 2005. We identified overpayments totaling nearly $2.3 million. For example, one dental clinic was overpaid $1.8 million because system controls had not been established to prevent duplicate payments for orthodontic services. We recommended that the Department recover the overpayments. When we followed up on the matters addressed in our prior audit report, we found that our recommendations had been implemented.

For a complete copy of Report 2007-F-18 click here.
For a copy of the 90-day response click here.