Faulty Electronic System Contributed to Medicaid Overpayments in N.Y.


Problems with an electronic system led New York's Medicaid program to issue millions of dollars in improper payments, according to two audits by the state comptroller's office, the AP/Wall Street Journal reports (AP/Wall Street Journal, 4/19).

Details of the Audits

The audits, conducted by Comptroller Thomas DiNapoli's office, examined whether the state Department of Health made improper premium payments to Medicaid managed care plans for covering beneficiaries dually eligible for Medicare and Medicaid.

Under state regulations, dual eligibles should not be enrolled in managed care plans because premiums typically exceed what Medicaid would pay for coinsurance and deductibles.

The first audit -- which covered June 2007 to May 2010 -- found that the state had issued about $36 million in improper Medicaid payments to cover dual eligibles.

The second audit -- which covered a six month period ending in March 2011 -- found that the state had issued about $6.3 million in improper Medicaid payments to cover dual eligibles (Solnik, Long Island Business News, 4/18). 

DiNapoli said, "When you are in both programs, Medicare is supposed to be the primary payer," adding that if beneficiary information is "not properly coded in the system, the state ends up [paying] more than it should."

Problems With the Electronic System

The audits identified problems with an electronic program called eMedNY, which processes the state's Medicaid claims (Mogul, WNYC, 4/18).

According to the comptroller, the improper payments resulted from delays in posting Medicare beneficiary data to eMedNY and delays in removing such beneficiaries from Medicaid managed care plans (Long Island Business News, 4/18). 

DiNapoli said the state has recovered $3.2 million in improper payments so far (AP/Wall Street Journal, 4/19). Department of Health officials said they are updating the eMedNY system and working to address the payment problems (WNYC, 4/18).

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