NYSDA Publications

HHS OIG Issues Report on New York State Making Improper Payments to Medicaid Managed Care Plans

The Office of the Inspector General (OIG) of the United States Department of Health and Human Services (HHS) has issued a report on the New York State Medicaid program making improper payments to Medicaid managed care plans for Medicaid recipients assigned more than one Medicaid identification number.  You can read the HHS OIG announcement of its findings on the New York Medicaid program, and access the complete report and a summary of the report, below.

New York Made Unallowable Payments Totaling More Than $9 Million to the Same Managed Care Organization for Beneficiaries Assigned More Than One Medicaid Identification Number

New York improperly claimed Federal Medicaid reimbursement for Medicaid beneficiaries who were assigned more than one Medicaid identification (ID) number.  Specifically, for 100 of the 105 beneficiary-matches in our sample, New York made managed care payments to the same managed care organization (MCO) for the same beneficiary for the same month under different Medicaid ID numbers.  On the basis of our sample results, we estimated that New York claimed at least $10.6 million in Federal Medicaid reimbursement for managed care payments made to the same MCO on behalf of beneficiaries assigned more than one Medicaid ID number.  We reduced our recommended financial disallowance to reflect payments New York refunded after our fieldwork.

Read the Summary
Read the Full Report