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Seniors are Not the Problem…

Seniors are Not the Problem when it comes to the Medicaid Budget. Before we cut necessary services for seniors, let’s stop the abuse.

Audits of the New York Department of Health (DOH) conducted by the Office of the New York State Comptroller last month found New York’s Medicaid program overpaid providers $11.4 million. The audits indicate that the two main reasons for the overpayments were providers overstating the amounts of Medicare coinsurance charges and because of incorrect rate changes.

While the state has already recovered $3.8 million of these overpayments, it seems that New York’s Medicaid system is suffering from an epidemic of waste and lack of control.

Since many of the state’s Medicaid recipients are also eligible for Medicare, after Medicare processes a claim, Medicaid pays the balance that is not covered by Medicare.

The auditors’ determined that as a result of providers incorrectly reporting the amounts of Medicare coinsurance charges, Medicaid overpaid more than 210,000 claims by more than $7 million. Instead of reporting the Medicare-approved amounts, providers reported their own charges for Part B services to Medicaid and thus inflated the amount they were reimbursed by Medicaid.

The auditor’s also identified about $4.1 million in overpayments as a result of incorrect retroactive rate changes that caused overpayments totaling $2.4 million, claims billed with inaccurate information from other health insurance plans, inpatient claims billed with high (intensive) levels of care that should have been based on less expensive “alternate” levels of care, and claims with improper payments.

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