The state Health Department shelled out $32.9 million more in Medicaid payments over five years, largely because multiple identification numbers had been issued to recipients, according to two audits released by Comptroller Thomas DiNapoli this week. A third audit found that the state missed out on $24 million in savings for physician-administered drugs.
“Due to a lack of basic oversight, overpayments such as these continue to plague the system,” DiNapoli said in a statement. “Previous audits have identified nearly $100 million in Medicaid overpayments resulting from people with multiple identification numbers and missed savings opportunities. There is no reason these problems should persist.”
In the first audit, the Health Department was found to have made $15.6 million in improper managed-care payments between 2005 and 2010 on behalf of 14,899 foster and long-term care recipients. Under state law, they were not eligible for enrollment in managed-care programs.
In the second audit, DiNapoli’s office discovered that the Health Department overpaid Medicaid providers by $17.3 million from 2007 through 2010 because local social-services districts improperly gave multiple ID numbers to almost 10,000 enrollees. Almost 90 percent of the errors were made by the New York City Human Resources Administration.
A third audit found that the Health Department failed to maximize rebate collections through the physician-administered drug-rebate program between 2008 and 2011. The agency delayed implementation of automated Medicaid system controls to enforce compliance with the rebate program. As a result, the system stopped nearly $8.5 million in rebate collections. Flaws in the collection process prevented additional rebates of more than $13.5 million, the audit said.
Another problems was medical providers billed Medicaid more than the discounted acquisition costs of the prescriptions, which led to missing out on nearly $2.3 million in savings.
DiNapoli said his auditors have identified numerous problems with the Health Department’s claims processing system, called eMedNY.