The overpayments were made between Jan. 1, 2012 and May 31, 2017, for administering free vaccines available through the Vaccines for Children Program. The program is a federally funded Medicaid benefit implemented by the CDC for children whose families may not be able to afford the shots.
The New York comptroller’s office reported that managed care organizations overpaid healthcare providers by $29.8 million during the audit period, while Medicaid overpaid by $2.9 million. Auditors said overpayments from managed care organizations occurred due to “control weaknesses” in claims-processing systems.
The report said the overpayments by Medicaid occurred because providers did not follow Medicaid policies for billing, and the payment system “lacked controls to prevent overpayments.”
Based on their findings, auditors recommended that managed care organizations be taught how to pay for the administration of vaccines and that claims-processing controls be implemented to prevent overpayments.
Access the full audit here.
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