Where Does All the Medicaid Money Go?

The NY Post reported that New York’s Medicaid program over paid managed care insurance premiums by more than $100 million between 2014 and 2018. 

“Auditors found that between 2014 and 2018, the state Department of Health made payments for managed-care premiums to 65,961 individuals with multiple client identification numbers.

The mix-up stemmed from missing or incorrect Social Security numbers and wrong addresses.

“System flaws and incorrect or incomplete information have caused duplicate Medicaid premium payments for a long time,” [State comptroller] DiNapoli said. “The Department of Health needs to do a better job.”

Yuh think? I’d say they really need to do a better job. 

No wonder physicians can’t be paid fairly for providing care. Of course, if a doctor had been over paid by a government plan, the doctor would face an investigation as to why the overpayment was not noticed by the physician and money returned immediately.

Do insurance companies face the same scrutiny as doctors? I doubt it, but to be fair, I researched the question. Were the insurance executives grilled by the Inspector General and forced to repay the money with interest and penalties?

A quick search revealed that this was not the first time private insurers who provide managed-care coverage for Medicaid clients were overpaid.  Last year, the NY Post reported that New York State overpaid insurers $1.3 Billion-Billion with a B- between 2012 and 2017. Those payments were for people who already had other health insurance and didn’t qualify for Medicaid. At that time the same State comptroller said,“The department needs to improve its procedures.” What is he going to do the next time? Say that the State really, really has to do a better job?

I hope they eventually figure out this payment thing, because New York State Legislators have made single payer health insurance a top priority for 2020. Then, they will be able to overpay insurance companies on behalf of every single New Yorker.