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Audits reveal NY state Medicaid overpayments worth millions

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  • Staff Report 

New York’s Department of Health (DOH) could save hundreds of millions of dollars by bolstering oversight of Medicaid and other public health plans enrollment, according to twin audits released on September 14 by State Comptroller Thomas P. DiNapoli. The findings spotlighted many occasions where the state’s Medicaid shouldered costs that should have been borne by federally-funded plans.

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DiNapoli’s scrutiny between July 2016 and June 2021 revealed that if 13,318 individuals, eligible for federally-funded Medicare, had enrolled, state Medicaid could have retained up to $294.4 million. This group includes 3,780 who became eligible during the pandemic. Despite the lack of mandatory Medicare enrollment during the health crisis, the audit estimated Medicaid could have preserved $37.3 million if these individuals had shifted to Medicare. Another audit, spanning January 2017 to November 2022, unveiled that despite Medicaid being the last resort payer, it wrongly paid the full amount, instead of the Essential Plan covering primary costs, resulting in an excessive expenditure of $93.7 million.

Following the audits’ recommendations for better enrollment oversight and the recovery of improperly billed costs, the DOH affirmed its commitment to streamline renewal processes and work alongside local departments to ensure Medicare-eligible members enroll promptly, aiming for substantial savings and potential cost recovery.