Purpose

To determine the extent of implementation of the two recommendations included in our initial audit report, Medicaid Overpayments for Out-of-State Ambulatory Surgery Services (Report 2009-S-29).

Background

Our initial audit report, which was issued on May 3, 2010, examined whether the Department of Health (Department) was appropriately paying out-of-state providers for ambulatory surgery services provided to New York State Medicaid recipients. For the period from April 16, 2004 through June 30, 2009, auditors identified $12.2 million in actual and potential Medicaid overpayments to out-of-state providers for such ambulatory surgery services. The overpayments happened because Department management failed to establish the correct payment rates on its eMedNY claims processing system and failed to provide for alternative manual claims review procedures to prevent the overpayments. The objective of our follow-up was to assess the extent of implementation, as of September 30, 2012, of the two recommendations included in our initial report.

Key Finding

• Department and Office of the Medicaid Inspector General officials made progress in addressing the issues we identified in the initial audit.  This included the recovery of $1,309,960.  Of the two prior audit recommendations, both have been implemented.

Other Related Audit/Report of Interest

Department of Health: Medicaid Overpayments for Out-of-State Ambulatory Surgery Services (2009-S-29)