OIG: New York paid $23.3 million in Medicaid payments to deceased beneficiaries
To date, New York has refunded approximately $10 million to the federal government and recovered roughly $19 million in unallowable payments.
Photo: John Rensten/Getty Images
An audit conducted by the Office of Inspector General (OIG) for the U.S. Department of Health and Human Services claims that the New York Department of Health improperly made $23.3 million in Medicaid capitation payments to managed care organizations for deceased beneficiaries.
Previous OIG audits showed other states had also made improper payments to MCOs for the same reason. That led the agency to conduct a similar audit in New York, which went from July 1, 2014 to December 31, 2018.
WHAT'S THE IMPACT?
The audit cited a few reasons for why New York made the allowable payments, including a lack of capabilities that would have pinpointed errors in the system that halts Medicare payments to MCOs for beneficiaries after they've died.
OIG recommended the state refund the federal share of payments to the federal government, and recover any unallowable payments that were made to the MCOs.
To date, New York has refunded approximately $10 million to the federal government and recovered roughly $19 million in unallowable payments.
OIG is urging states to ensure that MCO payments are made only for eligible enrollees. Strengthened oversight is necessary not only to address current issues, but to prevent future occurrences of improper payments, it said.
In response to the findings, the Department of Health has committed to reviewing OIG's recommendations and taking corrective actions.
THE LARGER TREND
In March the U.S. Government Accountability Office reported an estimated $236 billion in improper payments during fiscal year 2023, and of that amount, more than $100 billion came from Medicare and Medicaid.
The $236 billion in improper payments were reported by 14 agencies across 71 programs. More than $175 billion (74%) of errors were overpayments – for example, payments to deceased individuals or those no longer eligible for government programs. Some $11.5 billion were underpayments; $44.6 billion were unknown payments (meaning it's unclear whether the payment was an error); and $4.6 billion were cases where a recipient was entitled to a payment, but the payment failed to follow proper statutes or regulations.
There was some good news, though: Payment errors have declined since last fiscal year by about $11 billion. Eight program areas saw substantial declines in improper payments this past year. For example, payment errors under Medicaid dropped by $30 billion from the previous year.
Overall, while improper payments were down from last year, they remain higher than before the COVID-19 pandemic.
Jeff Lagasse is editor of Healthcare Finance News.
Email: jlagasse@himss.org
Healthcare Finance News is a HIMSS Media publication.
