State Auditors Save NY Taxpayers Millions Each Month in Medicaid Costs

Two New York state auditors in the Medicaid Inspector General’s Office decided to go back to the basics in their search for fraudulent activity. Beneath the complex schemes often investigated, lay the much simpler ones, in this case, patients’ addresses. The discovery revealed that managed care organizations were improperly billing the government health program; doing so based on where the patient was receiving the care instead of where they actually lived. As a result, some health care providers were getting more funds than the program allowed for.

To account for differences such as cost of living, allotments for Medicaid payments vary rather drastically from county to county.  Although most health care providers are located in counties zoned to receive high reimbursements, they are only to receive the payments calculated based on the counties in which their patients reside. Thus, for example, health care providers located in upscale neighborhoods in Manhattan servicing patients residing in rural upstate towns, are still supposed to receive reimbursement payments scaled to the addresses on file of their patients however, they are receiving much more by filing their own address with the government program.

Governor Andrew Cuomo announced that the error was costing New York taxpayers an additional $8 million each month in Medicaid costs. State officials are noting the “error” as just that, not intentional fraud; all the same, taxpayers and the state combined are now saving millions without a single cutback or compromise in care.

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