January 28, 2013
Mineola, NY - Nassau County Comptroller George Maragos released his review of the Nassau County Department of Social Services (DSS) Medicaid Unit’s effectiveness in managing Medicaid costs and preventing abuse. In 2011, the Medicaid Program spent approximately $1.8 billion while handling approximately 94,000 cases. The Medicaid Unit was found to be effective in managing the Medicaid Program with relatively few instances of weaknesses.
“We were pleased to find the Medicaid Unit operating efficiently, and protecting taxpayer money,” Comptroller Maragos said. “The Medicaid Unit and the Mangano Administration should be commended for handling a large and growing caseload with reduced staff and with little error while providing benefits to eligible residents.”
During the review auditors found only 13 cases, totaling $29,315, involving clients who moved out of state and who continued to erroneously have their Managed Care premiums paid. This represented about 0.014% of the total annual case volume managed by the Medicaid Unit. The Department reviewed these cases and was able to recover almost $9,000 to date. It also tightened policies to better safeguard taxpayer dollars.
Additionally, the auditors found that out of 23,183 new Medicaid cases processed in 2010, 10.7% or 2,482 required more than 45 days and 2.5% or 582 cases took more than 90 days to determine eligibility due to extenuating circumstances. On average, cases were disposed within 24 days. New York State law requires that disability cases be processed within 90 days and all others within 45 days. The Medicaid Unit has already implemented a proprietary tracking system to better track application type and due date.
The Medicaid Unit was also found to be effectively verifying applicant income and eligibility. In 2010 and in 2011 the Unit referred about 2,100 questionable applicants for formal investigation. The following are some examples of fraud which was uncovered:
All of these cases were referred to the Nassau County District Attorney’s Office for criminal fraud prosecution, and full restitution.
The total Medicaid cost per year in Nassau County amounts to approximately $1.8 billion. The County’s portion of this federal, state, and local program costs Nassau County taxpayers approximately $226 million or about 12.5% of the total expense.