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Comptroller DiNapoli finds $965M in billing errors in state Medicaid system

New York’s Medicaid system had almost $1 billion in billing errors, found an audit released on Tuesday by New York State Comptroller Tom DiNapoli.

The audit found that the state Department of Health (DOH) made $965 million worth of payments to providers and facilities not approved to treat Medicaid patients, according to News10 NBC. The state’s Medicaid program assists low-income and special needs New Yorkers.

Auditors uncovered that eMedNY, the DOH’s payment processing system, enabled providers no longer enrolled in Medicaid to use the system, thereby allowing improper payments. The audit spans from January 2015 to December 2019. In that time, $5.8 million in payments were received by providers previously excluded from the Medicaid system due to past behavior or actions.

DiNapoli recommended the DOH review the $965 million in payments and update its billing guidelines. The DOH stated they have taken action and plan to take further action. You can read the full report here.