An audit by New York State Comptroller Tom DiNapoli has revealed millions of dollars in questionable payments made by Medicaid-managed care organizations (MCOs) to providers who were not properly enrolled in the Medicaid program. Providers must be enrolled under federal and state law to receive payments for services provided to Medicaid recipients. The state Department of Health pays for Medicaid through fee-for-service and managed care arrangements.
The audit reviewed claims from January 2018 to June 2022 and identified $1.5 billion in improper and questionable payments. Examples of these included MCOs paying for services by providers whose identities did not match Medicaid enrollment records, services by providers whose Medicaid applications had been denied, and payments to providers who were excluded or ineligible for the Medicaid program.
Comptroller DiNapoli expressed concern over the findings, emphasizing the importance of ensuring the integrity of the Medicaid program for the millions of New Yorkers who rely on it for quality healthcare. He recommended that the Health Department improve its oversight of MCO claim payments, ensure compliance with enrollment requirements, and take appropriate action to address the improper payments identified in the audit.
The audit underscores the need for better enforcement of Medicaid provider enrollment requirements and stricter oversight to prevent improper payments by MCOs. By taking corrective action and recovering any misallocated funds, the Health Department can help safeguard the integrity of the Medicaid program and ensure that eligible providers receive proper compensation for services rendered.
Overall, this audit highlights a significant issue within New York’s healthcare system that needs immediate attention from policymakers. It is crucial that steps are taken to ensure that MCOs are properly reimbursed for services provided while also protecting patients from fraudulent practices within these organizations.
In conclusion, this audit brings attention to an important issue within New York’s healthcare system that requires immediate attention from policymakers. It is essential that steps are taken to ensure that MCOs are properly reimbursed while also protecting patients from fraudulent practices within these organizations.
