Review of the Network Design Group's Full and Partial Denials of Medical Assistance Claims That Have Not Been Recovered by New York State

EXECUTIVE SUMMARY:

This final audit report points out that New York did not take action to recoup overpayments ($1.7 million Federal share) identified by the Network Design Group (NDG), a peer review organization contracted with by New York State to review Medicaid claims. We recommended a financial adjustment and that New York ensure that all overpayments identified by peer review organizations are recovered timely and the Federal share refunded. Regional Health Care Financing Administration officials generally concurred with our findings and recommendations.