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April 18, 2014

New York sees $22.6M in Medicaid paybacks since 2010

Tonawanda News — A follow-up review by New York Comptroller Thomas DiNapoli’s office, after a 2010 audit charging the state Department of Health was overpaying millions in Medicaid receipts, finds “substantial progress” has been made in addressing the problem.

The follow-up audit issued this week says the state has reclaimed some $22.6 million in Medicaid payments made to more than 5,900 individuals who are also eligible for Medicare. 

“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,” the follow-up audit report states.

Since the initial report, the Department of Health has instituted new computer checks to help identify patients at hospitals, nursing homes and other health care facilities seeking coverage under Medicaid who are also eligible for Medicare.

A state contractor has now been instructed to check Medicaid claims under eMedNY for patients — particularly the elderly and disabled — who would seem an obvious match as eligible for Medicare coverage instead.

“The initial audit found 5,906 Medicaid recipients whose Medicare Part A coverage was not indicated on eMedNY. Since then, the recipients’ Medicare coverage was properly updated to eMedNY,” the report states.

Under state law, care providers are supposed to submit claims for Medicare-eligible patients to that program before applying for coverage under Medicaid. The initial report found there are about 780,000 New Yorkers who are eligible for both Medicare Part A and Medicaid.

In many instances documented in the 2010 audit, care providers were being paid by both Medicare and Medicaid for the same services provided to patients.

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