Purpose

To determine the extent of implementation of the eight recommendations included in our initial audit report, Medicaid Claims Processing Activity - October 1, 2008 through March 31, 2009 (Report 2008-S-155).

Background

Our initial audit report, issued December 22, 2009, examined whether the Department's eMedNY system reasonably ensured that Medicaid claims were submitted from approved providers, were accurately processed, and resulted in correct provider payments. We identified five reportable conditions. The first reportable condition entailed the identification and prevention of a potential $20.3 million overpayment resulting from a reimbursement rate that was incorrectly updated on a rate file loaded onto the eMedNY system. The remaining four reportable conditions resulted in overpayments of approximately $1.2 million.

Key Finding

Department officials have made progress in correcting the problems we identified in the initial report. However, improvements are still needed. Of the eight prior audit recommendations, five recommendations have been implemented and three recommendations have been partially implemented.

Key Recommendation

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

Other Related Audits/Reports of Interest

Department of Health: Medicaid Claims Processing Activity October 1, 2008 Through March 31, 2009 (2008-S-155)
Department of Health: Medicaid Claims Processing Activity April 1, 2012 Through September 30, 2012 (2012-S-24)