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Medicaid investigation off to good start for Cuomo

By John O'Brien | Aug 7, 2007


ALBANY, N.Y. - Approximately $7 million has been recovered from two managed care organizations, New York Attorney General Andrew Cuomo said Monday.

A series of joint audits and investigations led to the recovery of the money from Healthfirst and St. Barnabas Community Health Plan. The companies were alleged to be charging duplicate claim payments and damaging the state's Medicaid system.

"The billing for duplicate claims is costing New York's taxpayers millions of dollars," Cuomo said. "Managed care organizations must be more vigilant identifying duplicate charges so that taxpayer funds received in error are returned in a timely manner."

From July 1, 2000-Nov. 30, 2006, Healthfirst, it is alleged, submitted duplicate coverage claims for nearly 6,000 individuals who had more than one Client Identification Number. The company received duplicate monthly payments, averaging $126 per month in additional to supplemental monthly payments averaging $2,957.

The company has agreed to reimburse the approximately $6 million overpaid by New York. St. Barnabas' payment is much less at $902,000.

Cuomo said it is just the beginning of an investigation of more than 30 managed care operations that have state contracts to provide or arrange for health services to Medicaid and Family Health Plus patients.

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