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[lauerz]

Comptroller: Overpayments, errors cost Medicaid system up to $92 million

ALBANY — State Comptroller Thomas DiNapoli said today that his auditors found up to $92 million in Medicaid overpayments, billing errors and other problems and called on the state Health Department to step up scrutiny of the program and recover the money. In one audit, a Medicaid recipient in Poughkeepsie received taxi service that cost about $300 a day, five days a week, to visit her child at a long-term care facility in Albany. There was no medical reason for the trips, but the Dutchess County Department of Social Services approved them and paid out a total of $196,000, DiNapoli said.  

"Our audits keep finding that the safeguards designed to detect waste, fraud and abuse have failed over and over again. Multiple ID numbers, overpayments, payments for unnecessary services — it just goes on and on," the comptroller said in a statement.

"The Department of Health has to start protecting the taxpayers' money and fix the leaks in the Medicaid system. It's just costing taxpayers too much," he said.

DiNapoli released three audits today on the state's $45 billion Medicaid program and forwarded the information to the state Office of Medicaid Inspector General. The audits found that:

• The Health Department made more than $53 million in improper payments for 25,950 recipients who had more than one Medicaid identification number.

The comptroller said the Health Department agrees with the findings but because of agency policy, it is seeking to recover just $2.4 million of the $53 million. The $2.4 million was in duplicate premiums paid to managed-care plans, he said.

• The Health Department paid $21.5 million in claims that either were incorrect or were not processed correctly by eMedNY, the agency's claims processing system. The department paid $1.2 million that primarily went to incorrect neonatal claims and transportation services that were not medically necessary or were not provided, including the Poughkeepsie case.

Auditors prevented $20.3 million from being paid out in claims because the reimbursement rate in the system was incorrect.

• The department made $17.4 million in improper or potentially improper payments, including $5.4 million in overpayments to 10 hospitals that billed for patients who had been transferred to another hospital rather than discharged.

In one case, a patient spent 18 days in a hospital after being injured in an accident and was then transferred to another hospital. However, the hospital claimed the patient had been discharged and received $253,000 rather than $92,000. Hospitals get more money from Medicaid if a patient is discharged rather than transferred.

The Health Department generally agrees with the audits' findings, DiNapoli said.

In 2009, auditors have identified $169 million in overpayments and savings in the Medicaid program.

http://www.lohud.com/article/2009912220377

Comments

комментируют местные жители:

[lauerz.livejournal.com]

that Poughkeepsie resident needs to do jail time.
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Based on this fraud and abuse at the state level, who in his right mind would want to trust the federal government to do any better under Obama's national health care plan? Imagine the potential for corruption and waste. It boggles the mind.
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"The Health Department made more than $53 million in improper payments for 25,950 recipients who had more than one Medicaid identification number.

The comptroller said the Health Department agrees with the findings but because of agency policy, it is seeking to recover just $2.4 million of the $53 million. The $2.4 million was in duplicate premiums paid to managed-care plans, he said."

and you think what Bernie Madoff did was criminal? The state is drowning in red ink and they will not seek to collect more than $50 million? Something is horribly wrong here.
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Some jail time should go along with the falsh claims