ALBANY – Stat Comptroller Thomas DiNapoli has released reports on his investigation into issues within the State Department of Health Medicaid section.
The DOH allowed more than $1.5 billion in improper Medicaid payments over the course of several years due to errors in its billing system and may have exposed patients to unqualified and uncredentialed health care providers, according to the report.
“Troubling errors like the ones routinely identified by my auditors are extremely costly. They can also put patients at risk,” DiNapoli said. “By not fixing problems with the Department of Health’s eMedNY system and other issues, hundreds of millions of dollars more in taxpayer dollars could be misspent and unqualified providers could continue to treat Medicaid patients.”
The first report issued by DiNapoli’s auditors found that a significant number of claims were paid even though they did not have a proper National Provider Identifier (NPI) to ensure the ordering, prescribing, referring, or attending provider was properly qualified or credentialed, creating a risk for patients. Processing weaknesses in eMedNY, the Medicaid claims processing and payment system, allowed $1.5 billion in payments for Medicaid clinic and professional claims without an appropriate NPI.
The second report found that from January 1, 2015, through December 31, 2019, claims totaling $28.5 million were paid for Medicaid recipients who were reported as discharged from a hospital, but then admitted to a different hospital less than 24 hours later. These claims raise the possibility that the first hospital wrongly recorded a patient’s transfer as a discharge, which is a red flag that the claims are at a high risk of overpayment.
DiNapoli has recommended several changes to the Medicaid practices within the DOH. In their response, DOH officials agreed with the audit recommendations and said actions will and have been taken.
