Computer foul-ups cause $42M in Medicaid overpayments

New York State officials acknowledged they improperly paid more than $42 million for patients in Medicaid managed care plans, according to a post on iHealthBeat. Issues with the state's electronic Medicaid claims processing system--eMedNY--were the cause, according to audits conducted by the state comptroller's office.

Two separate state audits found that patients who were dually eligible for Medicare and Medicaid were improperly enrolled in Medicaid managed care plans, which is actually more expensive for the state. For dual-eligible patients, Medicare should be the primary payer, according to state comptroller Thomas DiNapoli.

The problem originated from delays in processing nearly 45,000 patients' eligibility, with the central system not being notified of their dual-eligible status, and removing those patients from the managed care plans, according to an Associated Press brief. The state has recouped $3.2 million of the improper payments so far.

New York isn't alone in Medicaid payment woes resulting from computer glitches. A few weeks ago, four Charleston, S.C.-area psychiatrists had to repay more than $344,000 in Medicaid payments because of computer problems that resulted in duplicate and erroneous billing, the Post and Courier reports. None of the physicians is charged with abusing the system.

And last month, we told you about computer glitches in Louisiana, Florida, Colorado and Maine that have caused untold headaches--claims delays, improper billing, unauthorized payments and more--to Medicaid programs.

To learn more:
- here's the iHealthBeat post
- read the AP brief
- check out the Post and Courier's coverage of the Charleston case

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