Review of Medicare Payments for Services Provided to Incarcerated Beneficiaries in New York State During the Period January 1, 1997 through December 31, 1999

EXECUTIVE SUMMARY:

The objective of this review was to determine whether Medicare fee-for-service claims paid in New York for beneficiaries identified as incarcerated during the period January 1, 1997 through December 31, 1999 were in compliance with Federal regulations and Centers of Medicare and Medicaid Services guidelines.  New York was one of 10 states selected for review.' We found 74 percent of our sample of 100 claims in New York were appropriate.' However, 16 claims totaling $597 were unallowable according to Medicare reimbursement requirements.' The claims were submitted on behalf of beneficiaries who were either undergoing a court ordered competency assessment (13 claims totaling $476) or were in correctional facilities (3 claims totaling $122).' In accordance with New York State law, medical care in these cases was the financial responsibility of the state.  We could not determine the allowability of 10 claims totaling $1,066.