Hospital stays over-billed, at taxpayer expense

Posted at: 07/25/2013 7:49 PM
Updated at: 07/25/2013 8:11 PM
By: Steve Flamisch

ALBANY -- New York State Comptroller Thomas DiNapoli criticized the state Department of Health (DOH) on Thursday for over-paying millions of dollars in Medicaid claims, but DOH said only a tiny fraction of the claims actually contained errors.

In a review of about 300 lengthy acute care admissions, an independent contractor found ten New York City hospitals over-billed -- and DOH overpaid -- 32 percent of the claims, according to an audit released by DiNapoli's office. The over-payments totaled close to $7.8 million.

"This is a misuse of taxpayer dollars and these types of mistakes should be stopped," DiNapoli said in a statement. "The Department of Health must make sure hospitals are being paid only for the services they provide."

DOH contended less than one-half of one percent of all Medicaid payments made between 2005 and 2010 were over-payments, and noted they pre-date the Cuomo Administration's overhaul of the Medicaid system.

"Auditors identified approximately $7.8 million in over-payments out of $26.3 billion in total payments over that five-year period," Marci Natale, DOH Deputy Director of Public Affairs, said in a statement. "That amounts to .03%, which is an extremely small error rate."

DOH has already recovered $3.8 million in over-payments and is working to recover the remainder, Natale said.

Four hospitals -- Bronx-Lebanon Hospital Center, Mount Sinai Hospital (New York), Maimonides Medical Center, and Kings County Hospital Center -- over-billed Medicaid for more than $1 million apiece, the audit found. Six other hospitals over-billed Medicaid in the six-figure range.

The Office of the Medicaid Inspector General will investigate whether their actions were fraudulent, Assistant Comptroller Jerry Barber told NewsChannel 13.

"That's difficult to assess," Barber said. "Clearly the hospitals had to prepare the claims incorrectly. It's very possible that it was error, misunderstanding, record-keeping problems. It's also possible that it's an attempt to maximize revenue."

DiNapoli's office has uncovered $1.64 billion in waste, fraud, and abuse, including close to $85 million this year, according to a press release from his office.

DOH contended that New York's Medicaid program, under Cuomo, has received national recognition for quality and cost effectiveness, with total expenditures declining despite increased enrollment.