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Dead got $3.4M in Medicaid from N.Y. Obamacare: audit

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NEW YORK DAILY NEWS

Thursday, October 29, 2015, 5:30 PM

JAN. 7 2013 FILE PHOTOMike Groll/ASSOCIATED PRESS

ALBANY — Death was not an impediment to receiving Medicaid benefits from New York’s Obamacare health insurance exchange, a new audit revealed.

The audit by State Controller Thomas DiNapoli’s office slammed the Health Department for lax controls that allowed hundreds of deceased individuals to receive Medicaid benefits and led to nearly $ 3.4 million in overpayments.

“We identified numerous system defects and process weaknesses that, left unaddressed, risk compromising the integrity of the state’s Medicaid program,” the audit stated.

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DiNapoli’s report also accused state health officials of denying auditors access to critical information that would have furthered the review.

“In the course of this audit, we experienced several impediments to our audit efforts,” the report stated.

The audit covered data from October 2013 through October 2014 and found that 354 deceased people were able to receive Medicaid benefits through the health exchange, which was in its first months of operation.

Of the 354 deceased people, 21 died after they applied for coverage but before they were formally enrolled in Medicaid. The remainder died after they were enrolled.

The state paid at least $ 325,030 to managed care providers for claims associated with 230 of the 354 deceased enrollees, the audit found.

DiNapoli’s auditors also found that the exchange often created multiple account numbers for individual enrollees, costing taxpayers as much as $ 3 million in overpayments.

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State health officials defended the exchange, noting that the audit covered a period when the health exchange was in its infancy and arguing that the federal government has been slow to initiate a program to check enrollees against death records.

Officials also rejected DiNapoli’s claim that auditors were denied access to information.

“To accommodate (the controller), the department offered to pull case samples and to provide (the controller) opportunities to conduct ‘over the shoulder’ reviews of eligibility determinations,” said Health Department spokesman James Plastiras.

“These offers were declined by OSC auditors, who instead chose to rely on the Medicaid claims processing system, which only permits the user to look up enrollees on an individual basis. In other words, the only impediments to the audit were created by the OSC auditors.”

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Health – NY Daily News

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