The New York State Office of the Medicaid Inspector General announced on October 30 that it has recovered the single largest monetary recovery in its history, a sum of $211 million. The repayment stems from an investigation of payments made on behalf of dually-eligible individuals, who are eligible for both Medicaid and Medicare. The overpayments were identified within the Third Party Liability Home Health Care Demonstration Project, which targeted dual-eligible populations who received home health care.
Notably, the audit that led to this recovery was conducted using a sampling technique, rather than an individual, case-by-case analysis of each claim submitted. The audit indicated that in some cases, Medicaid was billed first for services rendered to the beneficiary and then Medicare was billed, rather than the other way around.
The OMIG’s press release in this matter may be viewed here: http://www.omig.ny.gov/latest-news/697-496-million
Caitlin Monjeau contributed this post.