News about potential fraud and waste within the New York Medicaid system keeps on coming. It seems as if every week there is a new allegations of practices which unnecessarily cost the state money in unnecessary Medicaid payments. With Governor Cuomo’s continued focus on rooting out problems with the system, we can likely expect even more information to come out regarding these issues in the next few months.
In fact, just last week the Capitol Confidential published a story discussing how the New York Comptroller, Tom DiNapoli, recently released two new audits which suggest widespread waste in the system.
One of those audits suggests that the NY Department of Health paid out more money for certain procedures than is allowed under current Medicaid rules. The administrative rules for Medicaid set specific maximum rates for certain procedures. Care providers—from nursing homes to hospitals–know those set rates. Those facilities do not necessarily get to set their own price.