NEW YORK: MAY HAVE BEEN OVERBILLED FOR MEDICAID
"New York may have paid out millions of dollars in MedicaidThis is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.
claims because lax state oversight failed to prevent double-
AP/Newsday reports. According to the state comptrollers office,
some health care providers may also charge Medicaid for services
"even when federal Medicare dollars should cover the costs." The
auditors report found that in 1994, New York "overpaid about $8.2
million in Medicaid." New York spends more than any other state
on Medicaid, $23 billion annually, to cover more than three
million people. However, the state does not have a "billing
system to detect" duplicate billings to Medicaid and Medicare.
There are approximately 513,000 New Yorkers eligible for both
Medicaid and Medicare. Because Medicaid "is the 'payer of last
resort,'" providers should first bill Medicare for treatment.
However, this frequently does not happen, even when Medicare is
Auditors suggested that New York develop a system similar to
those of six other large states that would help detect duplicate
billings and inappropriate Medicaid billings. State Comptroller
Carl McCall said, "States such as California and Ohio have
automated crossover billing systems in place to prevent duplicate
payments to health care providers and ensure that Medicare and
Medicaid are properly billed." According to State Health
Department spokesperson Frances Tarlton, the state will "have a
pilot program in place January 1, which would eventually be
expanded statewide." McCall added that "[i]n light of President
Clinton's recent line-item veto of legislation that would
legitimize New York taxes designed to bring more federal Medicaid
dollars into the state, 'it becomes even more crucial that New
York spend every Medicaid dollar wisely and efficiently'" (8/20).