Computer problem leads to questionable Medicaid payments

A new audit from Comptroller Thomas DiNapoli found more than $26 million in potentially improper Medicaid payments due to flaws in the Department of Health’s claims processing computer system.

The Health Department implemented a new payment mechanism within its claims system in 2009. DiNapoli’s office said it found the system was not working correctly through March 31, 2012. That allowed nearly 866,000 improper and questionable payments, according to the comptroller’s office.

The problem caused $10 million in overpayments and $16.4 million in potential overpayments.

“Taxpayers should not be forced to foot a $26 million bill due to computer programs that are poorly designed and lack controls to prevent inappropriate payments,” DiNapoli said in a news release. “The Department of Health needs to do better in ensuring that taxpayer money for critical Medicaid services is not wasted. This money must be recovered and controls to avoid overpayments must be put in place.”

The new mechanism was an attempt to ensure Medicaid did not pay claims denied by Medicare in situations where a patient is eligible for both programs. The idea was to help Medicaid pay only the portion of the claim it actually owes, according to DiNapoli’s office.

Contact Tampone at ktampone@cnybj.com