DiNapoli Finds More Medicaid Over Payment by State
According to an audit released by State Comptroller Thomas DiNapoli, the state Department of Health made as much as $31 million in excessive Medicaid payments for patients who died within 24 hours of being admitted to a hospital after a new method of calculating hospital payments went into effect.
For the fiscal year ending March 31, 2012, New York’s Medicaid program had more than 5.5 million enrollees, and Medicaid costs totaled more than $50 billion. During that period, Medicaid paid hospitals approximately $5.5 billion for inpatient services.
Due to a December 2009 change in the law, the Medicaid program implemented a new inpatient reimbursement methodology based on the severity of illness, the risk of mortality and other factors. The previous reimbursement methodology was based primarily on the length of a patient’s hospital stay.
DiNapoli’s auditors found that since DOH started using the new methodology, Medicaid has paid significantly more for claims when patient deaths occur within the first day of admission. DiNapoli’s auditors further determined the state could have saved as much as $31.1 million if the 1,833 questionable claims were calculated under modifications similar to those made for another type of claim in 2011.