NY: Hospitals, nursing homes overpaid by $77 million

New York regulators believe that hospitals may have received more than $31 million in Medicaid payments for short-stay patients who died not longer after being admitted, the Albany Times-Union reported.

The state Office of the State Controller reached that conclusion after auditing 1,833 claims submitted to the New York Department of Health. It concluded that Medicaid paid on average 225 times the actual hospital costs. In one instance, Medicaid paid more than $153,000 on a claim where the hospital charges were $9,685, the Times-Union reported.

The gaps between billing and payment is the result of a methodology New York introduced in 2009, according to the article. It uses the All Patient Refined Diagnosis Related Groups or APR DRG.

In a separate audit, DiNapoli concluded that the state's nursing homes that treat Medicaid patients also overcharged the state by $46 million because it failed to deduct payments made by patients, the Times Union reported.

"Over and over again, my auditors are finding poor oversight of payments and other big problems that have led to tens of millions of dollars of waste in the Medicaid program each year,"DiNapoli said in a statement. "While DOH worked with the Office of the Medicaid Inspector General to recover these overpayments, there is much more that needs to happen to prevent the payments from occurring in the first place."

To learn more:
- read the Times-Union article on the hospital overpayments
- here's the Times-Union article on the nursing home overpayments
- check out DiNapoli's statement
- read DiNapoli's report (.pdf)