A new audit by the New York Department of Health has found that the state's Medicaid program overpaid providers by almost $26 million over a five year period. The problems occurred, auditors found, because controls within the Department's electronic claims processing system were not being used, and what's more, that the clinics weren't following the state's Medicaid billing guidelines. The payments, which took place from 2001 through 2006, went to clinic services for hospitalized Medicaid enrollees. Clinics inappropriately billed the state for more than $25.7 million, which included $17.7 million for services provided during an inpatient stay and $8 million for clinic and emergency department services the same day the patient was admitted. However, Medicaid rules say that if a patient is admitted directly to a hospital, no separate payments should be made for ED or clinic services. Instead, the hospital receives a single all-inclusive payment.
To learn more about the overpayments:
- read this Business First of Buffalo article