Department of Health

Medicaid Payments for Human Immunodeficiency Virus (HIV) Drug Resistance Testing (Follow-Up Report)

Human Immunodeficiency Virus (HIV) drug resistance testing is used to establish more effective treatment plans for HIV infected patients who become resistant to medications used to treat the virus. In New York State’s Medicaid program, such testing is reimbursable on a fee-for-service basis up to a maximum of three tests per recipient per year. However, in audit 2007-S-13, during our five year audit period, we found that this maximum testing threshold was exceeded for a number of Medicaid recipients, and as a result, about $1.27 million in Medicaid overpayments were made. We recommended that the overpayments be recovered and Medicaid claims processing controls be improved to prevent such overpayments in the future. When we followed up with Department of Health officials, we found that little progress had been made in implementing our audit recommendations.

For a complete copy of Report 2009-F-39 click here.