Objective

To determine the extent of implementation of the ten recommendations included in our initial audit report, Improper Managed Care Premium Payments for Recipients With Duplicate Client Identification Numbers (Report 2018-S-24).

About the Program

The Department of Health (Department) administers the State’s Medicaid program. Each individual who applies for Medicaid benefits is assigned a Client Identification Number (CIN), a unique identifier. Medicaid recipients may have more than one different CIN assigned to them during the time they are in receipt of benefits (herein referred to as “duplicate CINs”); however, only one of the CINs should have active eligibility at a time. The Department’s Medicaid claims processing and payment system relies on eligibility and enrollment information, including the assignment of CINs, from the NY State of Health and the downstate and upstate Welfare Management Systems to make appropriate Medicaid payments.

We issued our initial audit report on July 29, 2019. The audit objective was to determine whether improper Medicaid managed care premiums were paid on behalf of recipients with duplicate CINs. The audit covered the period January 1, 2014 to June 30, 2018. The initial audit identified over $102.1 million in improper managed care premium payments on behalf of 65,961 recipients with duplicate CINs. Many of the problems were due to incorrect/missing recipient demographic information and limited access to the multiple eligibility systems during the application process.

The Department, Local Departments of Social Services, managed care organizations, and the Office of the Medicaid Inspector General all have processes to identify and resolve duplicate CINs; however, their systems were not fully integrated so there was no central tracking database.

We recommended that the Department review the improper payments we identified and make appropriate recoveries; ensure Local Departments of Social Services make timely and accurate updates to demographic information on all Medicaid cases; evaluate the feasibility of building a central tracking database of potential duplicate CINs; and implement improvements to the duplicate CIN research and resolution process.

Key Findings

Department officials made significant progress in addressing the problems identified in the initial audit report, including enhancing certain controls to prevent the creation of duplicate CINs and recovering nearly $51 million, but additional action is still required to prevent future improper managed care premium payments. Of the initial report’s ten audit recommendations, eight were implemented and two were partially implemented.

Key Recommendation

Officials are given 30 days after the issuance of the follow-up report to provide information on any actions that are planned to address the unresolved issues discussed in the follow-up report.