Department of Health

Under Reporting of Net Available Monthly Income for Nursing Home Residents Causes Medicaid Overpayments

Many Medicaid nursing home recipients have income from Social Security, pensions and other sources. This is referred to as Net Available Monthly Income (Monthly Income). Localities must provide this information to the Department of Health's (Department) eMedNY computer system, which processes nursing home provider claims for Medicaid reimbursement. Then, eMedNY is supposed to deduct the Monthly Income from the amount that Medicaid pays to the nursing home provider. However, we found that these payments were not being reduced by the Monthly Income amounts. As a result, we estimate that up to $42 million of Medicaid money was overpaid to nursing homes during our 44-month audit period. The State and local portion of the potential overpayment was about $21 million.

For a complete copy of Report 2010-S-17 click here.