OIG Forwards State Comptroller Audit Findings to CMS

The Office of Inspector General (OIG) forwarded the New York State Comptroller's Dec. 28, 2020 audit report, Medicaid Program: Improper Medicaid Payments for Individuals Receiving Hospice Services Covered by Medicare, to the Centers for Medicare and Medicaid Services (CMS) in late April. The objective of the State Comptroller’s audit was to determine whether the New York State Department of Health (DOH) made improper Medicaid payments to providers on behalf of dually eligible individuals receiving hospice care covered by Medicare during the period Jan. 1, 2015 through July 31, 2019. The OIG memo to CMS is available here.

As part of OIG's efforts to partner with State auditors and expand coverage of the Medicaid program, OIG assisted the State Comptroller with its audit by:

• matching Medicare hospice claims from CMS’s National Claims History and Medicaid claims from the Transformed Medicaid Statistical Information System to identify all Medicaid services provided to Medicare hospice beneficiaries, and providing the resulting Medicaid matches to the State Comptroller;
• assessing the reliability of select Medicare hospice claims data;
• attending key meetings with the State Comptroller auditors;
• monitoring the progress of the State Comptroller’s audit.

The State Comptroller recommended that DOH review the actual and potential overpayments identified in the audit report and ensure that proper recoveries are made. In addition, the State Comptroller made several other recommendations to DOH, including that it improve controls to prevent improper payments for services provided to dually eligible individuals receiving Medicare-covered hospice care and that it coordinate with CMS, as appropriate, to design and implement a process to identify and track all Medicaid beneficiaries who elect Medicare-covered hospice care.

In its comments on the State Comptroller’s report, DOH stated that it will establish a work group to review these issues and develop monitoring and/or control activities to ensure that services are appropriately paid for individuals receiving Medicare-covered hospice care. 

The State Comptroller's report will be posted here.

Contact: Meg Everett, meverett@leadingageny.org, 518-929-9342