News Summary
A recent audit by Comptroller Tom DiNapoli indicates that New York may have overpaid nearly $1.2 billion in Medicaid managed care premiums for individuals not residing in the state. The audit uncovered shortcomings in the Department of Health’s ability to verify residency, leading to substantial improper payments. Proposed improvements include enhancing verification processes and better coordination with federal officials to recover funds. This audit highlights significant management issues within the Medicaid program as New York faces rising spending concerns.
New York Audit Reveals $1.2 Billion Medicaid Overpayments
A state audit released by Comptroller Tom DiNapoli has revealed that New York may have improperly paid nearly $1.2 billion in Medicaid managed care premiums for members who may not actualize residency within the state. The audit, which examined transactions from July 2017 to October 2024, raises significant concerns regarding the management and oversight of New York’s Medicaid program.
The audit highlights that the New York Department of Health (DOH) failed to effectively verify the residency of Medicaid members and has been slow to recover improper payments. Most of New York’s Medicaid members are enrolled in managed care plans, which are responsible for ensuring healthcare service access and provider reimbursements. As part of this system, DOH makes monthly premium payments to these managed care plans for each member enrolled.
According to the findings, federal law prohibits Medicaid payments for non-residents; however, DOH allegedly did not perform thorough residency verifications. The audit indicated that approximately $509 million in monthly payments were made for over 155,000 members who may no longer reside in New York.
Failures in Oversight and Residency Verification
The lack of proper residency verification led to payments being processed without adequate oversight. The audit reveals that DOH did not begin reviewing residency information from the Public Assistance Reporting Information System (PARIS) until 2019. By this time, DOH had already issued $1.5 billion in payments for unverified members, raising serious questions about administrative controls and financial management within the program.
Recommended Improvements
To address these discrepancies, the comptroller recommended that DOH enhance its residency verification process, improve coordination with federal officials, and pursue recovery of improper premium payments where applicable. DOH officials have generally agreed with the findings of the audit and indicated that they are taking steps to rectify the identified issues.
Broader Implications for Medicaid Spending
The audit occurs against a backdrop of historical issues with New York’s Medicaid program, which is projected to see spending increase by $6 billion in the upcoming fiscal year. Furthermore, recent federal cuts to Medicaid under the Trump administration have raised concerns about potential coverage loss for up to 1.5 million New Yorkers.
Comparison with Other States
The report also notes that New Jersey, Florida, and Pennsylvania were among states where unverified Medicaid payments were directed, indicating that this issue may not be confined to New York alone. The $1.2 billion in potential overpayments represents an ongoing challenge as the state aims to manage Medicaid costs and prevent abuse of the program.
This audit serves as a crucial reminder of the importance of stringent oversight and accountability in government welfare programs as New York strives to uphold the integrity of its Medicaid system while ensuring that resources are allocated to those who genuinely require assistance.
Deeper Dive: News & Info About This Topic
- Times Union: State Health Department Spent $1.2B on Non-NY Residents
- Wikipedia: Medicaid
- CBS 6 Albany: NYS Audit Reveals $1.2 Billion Medicaid Overpayments
- Google Search: New York Medicaid overpayments
- Spectrum Local News: N.Y. May Be Paying Medicaid Premiums for People Living Out of State
- Google Scholar: Medicaid oversight New York
- Finger Lakes Daily News: Audit: NY Paid $1.2B in Medicaid Premiums for Non-Residents
- Encyclopedia Britannica: Medicaid Program
Author: STAFF HERE NEW YORK WRITER
NEW YORK STAFF WRITER The NEW YORK STAFF WRITER represents the experienced team at HERENewYork.com, your go-to source for actionable local news and information in New York, the five boroughs, and beyond. Specializing in "news you can use," we cover essential topics like product reviews for personal and business needs, local business directories, politics, real estate trends, neighborhood insights, and state news affecting the area—with deep expertise drawn from years of dedicated reporting and strong community input, including local press releases and business updates. We deliver top reporting on high-value events such as New York Fashion Week, Macy's Thanksgiving Day Parade, and Tribeca Film Festival. Our coverage extends to key organizations like the Greater New York Chamber of Commerce and United Way of New York, plus leading businesses in finance and media that power the local economy such as JPMorgan Chase, Goldman Sachs, and Bloomberg. As part of the broader HERE network, including HEREBuffalo.com, we provide comprehensive, credible insights into New York's dynamic landscape.
