State audit finds $1B in ‘unnecessary’ Medicaid premium payments
An audit released by
DiNapoli chalked up the costly payments to "glitches" in the health department's payment system and "other problems" that led to what he described as "unnecessary spending."
"The department needs to improve its procedures and stop this waste of taxpayer money," DiNapoli concluded.
Medicaid, a federal, state and locally funded program managed by DOH, provides a wide range of health care services to those who are economically disadvantaged or have special health care needs. For the state fiscal year ended
Under managed care, Medicaid pays managed care organizations (MCOs) a monthly premium for each enrolled Medicaid recipient and the MCOs arrange to provide medical services. As of
DiNapoli's office indicated that many Medicaid recipients have additional sources of health care coverage while noting that DOH's policy is to exclude Medicaid recipients from mainstream managed care when they have concurrent comprehensive third-party health insurance. When the Medicaid managed care provider and the third-party provider are the same, the state can remove the recipients from managed care retroactively and recover the unnecessary premiums paid to the MCO, according to rules in the Medicaid Managed Care Model Contract. Auditors found that was the case for
About
DiNapoli suggested officials at the state department of health should review these relationships to confirm if the premiums are recoverable.
DiNapoli's auditors noted, however, that
DOH often learns of enrollees' third-party coverage after the coverage has taken effect. Of the
Medicaid also paid more than
In releasing his office's findings, DiNapoli recommended that the department of health:
--improve monitoring efforts to assist in the prevention, detection and recovery of inappropriate managed care premiums;
--implement controls to remove non-NYSOH-enrolled recipients with comprehensive third-party health insurance from managed care;
--review the managed care premiums identified and recover unnecessary payments; and
--change the model contract language to allow the recovery of unnecessary premiums from all MCOs regardless of the relationship with recipients' third-party insurer.
DOH officials generally agreed with most of the audit recommendations and indicated that certain actions have been and will be taken to address them.
DiNapoli's auditors worked with
Auditors are also working with
In May of 2018, DOH requested the methodology that auditors used to identify enrollees with concurrent Medicaid managed care coverage and comprehensive third-party health insurance. The Medicaid Inspector General's office is currently engaged in a "clean-up project" to disenroll members from managed care who had comprehensive third-party health insurance during January of 2018.
To read the full report, visit www.osc.state.ny.us/audits/allaudits/093018/sga-2018-16s60.pdf
___
(c)2018 the Niagara Gazette (Niagara Falls, N.Y.)
Visit the Niagara Gazette (Niagara Falls, N.Y.) at www.niagara-gazette.com
Distributed by Tribune Content Agency, LLC.
Global Stocks Sink After Fed Hikes Rates
Gov. Ige Signs Request for Federal Individual Assistance Programs for Hawaii County in Wake of Volcanic Eruption
Advisor News
Annuity News
Health/Employee Benefits News
Life Insurance News