NYSDA Publications

OSC Issues Three Audits on Improper Payments By Medicaid

The Office of the New York State Comptroller (OSC) has issued three audit reports on improper payments by the New York State Medicaid program.  OSC found millions of dollars in improper Medicaid payments had been made and that Medicaid failed to screen claims adequately to ensure cost savings or eligibility for payment.  You can read the OSC notice of its three Medicaid audits, and can access the complete audits, below.

Department of Health (Medicaid Program) – Cost Saving Opportunities on Payments of Medicare Part C Claims (Follow-Up) (2022-F-14)

For Medicaid recipients who are also enrolled in Medicare, Medicaid typically pays for any cost-sharing liabilities, such as Medicare deductibles, coinsurance, and copayments.  The 2021 initial audit found that New York’s current Medicaid payment rules for recipients also covered by Medicare Part C cost-sharing liabilities have significantly higher costs compared to the allowable alternatives.  The initial report’s audit recommendation was not implemented because Department of Health officials declined to take actions to address the potential cost savings identified.

Department of Health (Medicaid Program) – Improper Medicaid Payments Involving Fee-for-Service Claims for Recipients With Multiple Client Identification Numbers (Follow-Up) (2022-F-2)

Each individual who applies for a Medicaid benefit is assigned a Client Identification Number (CIN).  Although Medicaid recipients may have more than one CIN, only one CIN should have active eligibility at a time.  Auditors initial report, issued on September 17, 2020, identified $47.8 million in improper Medicaid payments on behalf of recipients with multiple active CINs.  The follow up found officials have made little progress in addressing the problems identified in the initial audit report and significant action is still required.  Of six initial audit recommendations, two were partially implemented and four have not been implemented.

Department of Health (Medicaid Program) – Improper Medicaid Payments for Terminated Drugs (Follow-Up) (2022-F-7)

Auditors issued our initial audit report on September 17, 2020.  The audit objective was to determine whether the Medicaid program made improper payments for drugs dispensed after they were removed from the market (terminated) for safety or commercial reasons.  The audit concluded the State’s Medicaid program improperly paid $29 million for drugs dispensed after their termination date.  Department officials made minor progress in addressing the problems identified in the initial audit report.  Also, since the initial audit, Medicaid improperly paid another $11 million for drugs dispensed after their termination date, some of which were recalled for safety reasons.  Of the five initial audit recommendations, two were implemented and three were not.

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