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Over $22 million in improper Medicaid payments processed in New York, audit finds

Comptroller Thomas DiNapoli has conducted an audit of the Medicaid claims processing program of the Department of Health and found over $22 million in improper payments from October 2021 to March 2022.

He reported that $11.5 million was spent on managed care premiums for Medicaid recipients who already had comprehensive third-party insurance and $8.9 million was used on clinic, practitioner, inpatient, managed care, and laboratory claims that violated Medicaid policies such as exceeding billing limits.


The Department of Health acknowledged that they perform continuous audits through the Office of the Medicaid Inspector General and will keep working to recover overpayments.

By the end of the audit, $9.9 million of the improper payments were recovered. During the audited period, the DOH processed 294 million claims and made payments to providers totaling $42 billion.



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