Review of the Island Peer Review Organization's Denials of Full Medical Assistance Claims That New York State Identified as Pended or Denied Through the Automated Void Process

EXECUTIVE SUMMARY:

This final audit report points out that 846 Medicaid hospital claims denied by the State's peer review organization were not processed for recoupment by the State's fiscal agent. The claims totaled $2.0 million (Federal share) and were not recovered due to system limitations in the State's Medicaid Management Information System, clerical errors, and lack of follow-up. We are recommending financial adjustments where appropriate and that the State institute procedures to preclude this problem from recurring. Both State and Health Care Financing Administration officials concurred with our findings and recommendations.