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. In audit report 2008-S-4, 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. 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. When we followed up, we found that Department officials have made progress in correcting the problems we identified. However, additional improvements are needed.

For a complete copy of Report 2010-F-21 click here.