Department of Health

Inappropriate Payments for Medicaid Recipients Residing and Enrolled in Other States

According to federal reports, during the period April 1, 2004 through May 31, 2008, the Department of Health made $28.4 million in Medicaid payments on behalf of New York State Medicaid enrollees who were also enrolled in another state’s Medicaid program. We found that the Department had not taken steps to effectively ensure that local social services districts acted in a timely manner to either investigate the enrollees identified on the reports or to remove them from New York’s Medicaid program. For example, the Department had not worked with the local districts to establish policies, procedures and time frames for completing investigations. In addition, the Department had not set up monitoring mechanisms to track the actual timeliness of the investigations, which often took more than two months to complete. We also found that the Department was not taking any steps to recover inappropriate managed care premiums paid on behalf of enrollees who no longer resided in New York State. We recommended that the Department strengthen its oversight of local district investigative efforts and pursue the recovery of inappropriate Medicaid payments whenever feasible.

For a complete copy of Report 2008-S-4 click here.