Medicaid Payments for Medicare Part A Beneficiaries (Follow-Up)

Issued Date
April 04, 2014
Agency/Authority
Health, Department of (Medicaid Program)

Purpose

To determine the extent of implementation of the four recommendations made in our audit report, Medicaid Payments for Medicare Part A Beneficiaries (2009-S-36).

Background

Our initial audit report, which was issued on September 20, 2010, examined whether Medicaid made overpayments for recipients who were also enrolled in Medicare Part A. Medicare Part A provides supplementary medical insurance for inpatient care in hospitals, post-hospital nursing home care, hospice, and home health services. If an individual is enrolled in both Medicaid and Medicare (commonly referred to as "dual-eligible"), Medicare is the primary payer and generally covers most of the eligible costs for health services. Medicaid, as a secondary payer, generally pays a small portion of the costs, such as coinsurance or deductibles.

For the two years ended December 31, 2007, our audit identified $14 million in potential Medicaid overpayments for claims pertaining to 2,564 dual-eligible individuals. We recommended that the Department of Health improve its detection of Medicare Part A coverage for Medicaid recipients and prevent improper payments.

Key Finding

Officials made considerable progress in correcting the problems we identified in the initial audit report. This included the recovery of approximately $22.6 million in Medicaid overpayments for services provided to recipients who were also covered by Medicare Part A. Of the initial report’s four recommendations, three were implemented and one was not implemented.

Key Recommendation

Officials are given 30 days after the issuance of the follow-up report to provide information on any actions that are planned to address the unresolved issues discussed in this report.

Other Related Audit/Report of Interest

Department of Health: Medicaid Payments for Medicare Part A Beneficiaries (2009-S-36)

Brian Mason

State Government Accountability Contact Information:
Audit Director: Brian Mason
Phone: (518) 474-3271; Email: [email protected]
Address: Office of the State Comptroller; Division of State Government Accountability; 110 State Street, 11th Floor; Albany, NY 12236