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Report File
Date Issued
Submitting OIG
Department of Health & Human Services OIG
Other Participating OIGs
Department of Health & Human Services OIG
Agencies Reviewed/Investigated
Department of Health & Human Services
Report Number
A-04-19-06223
Report Description

New York pays managed care organizations (MCOs) to make services available to enrolled Medicaid beneficiaries in return for a monthly fixed payment for each enrolled beneficiary (capitation payments). The New York Medicaid Assistance Program (New York Medicaid) is the second largest Medicaid program in the Nation. New York Medicaid provides health coverage to almost 6.2 million of New York's residents. Approximately 80 percent of the New York Medicaid population is enrolled in managed care.

Report Type
Audit
Location

NY
United States

External Entity
State of New York

Open Recommendations

This report has 4 open recommendations.
Recommendation Number Significant Recommendation Recommended Questioned Costs Recommended Funds for Better Use Additional Details
269125 No $0 $0

Identify and recover capitation payments made on behalf of deceased beneficiaries before and after our audit period, and repay the Federal share of amounts recovered

269126 No $0 $0

Create system edits to help identify overpayments and failures in the automated interfaces between the eligibility, payment, and death data

269127 No $0 $0

Use additional sources of date of death consistently to help reduce unallowable payments

269123 No $13,696,760 $0

Refund $13,696,760 Federal share to the Federal Government

Department of Health & Human Services OIG

United States