Politics on the Hudson

   New York State needs to shape up its Medicaid claims system, state Comptroller Thomas DiNapoli said. The state has made millions of dollars in improper payments to health-care providers due to inadequate oversight and other problems, the comptroller found in an audit. Medicaid, which provides health care for the poor and disabled, is the state’s most expensive program and costs $42 billion annually.

   DiNapoli’s review of the Medicaid system found there were $1.8 million in overpayments to providers that incorrectly billed Medicaid for Medicare Part B services. In many cases, the providers either double-billed the services or did not accurately report payment information on claims, according to the audit.

    “We need to make sure all those dollars are spent carefully. But our auditors continue to find systemic problems with the Department of Health’s Medicaid claims processing system. Questionable claims keep slipping through. At a time when state and local governments are facing record deficits, we have to scrutinize all spending and use every tool available to detect fraud and billing errors,” DiNapoli said in a statement.

   The Comptroller’s Office has issued several audits identifying problems with the claims processing system. Auditors found $55 million in overpayments or improper payments last year because aspects of the system were not properly set up, not set up at all or not functioning as intended.

   Read on for some quick facts about the state’s Medicaid Program.  —The funding is 50 percent federal, 34 percent state and 16 percent local governments.

  —There are about four million Medicaid recipients in New York.

  —About 60,000 health-care providers receive Medicaid payments from the state.

  —More than 342 million Medicaid claims are processed annually.

  —Experts estimate that at least 3 percent of the nation’s annual health-care costs are lost to fraud. That amounts to $1.3 billion in New York. 

|  Email This