Sneak Preview: N.Y. Auditor Seeks Review of Medicaid Eligibility

December 23, 2015 | By Jerry Ashworth | Post a Comment

xsass_bookshot(The following was excerpted from a recent article in the Single Audit Information Service.) The New York Department of Health is updating the functionality of its Medicaid information system to enable state auditors to better review applicant eligibility and enrollment information. In a recent audit, the New York Office of State Comptroller (OSC) said that the system was not capable of providing auditors with information they needed to determine applicant eligibility, and the health department did not provide them with useful data as an alternative.

The state comptroller audited the New York State of Health system between Oct. 1, 2013, and Oct. 1, 2014, to evaluate whether it had adequate controls to ensure accurate enrollments in the state Medicaid program and whether improper enrollments led to Medicaid overpayments. The system, created as a result of the Patient Protection and Affordable Care Act of 2010 (Pub. L. 111-148), is an online marketplace for individuals to obtain health insurance coverage, including Medicaid. Individuals applying for assistance receive a client identification number, and the health system is required to conduct various checks across data systems to verify applicants’ eligibility linked to this identification number. The state health department contracted with Computer Sciences Corporation (CSC) to build the health system.

In its audit, however, the comptroller noted that the health department did not provide its auditors with adequate access to information in the health system. “Due to this limitation and other scope impairments, we were unable to assess the adequacy of controls over Medicaid enrollments and fully determine the extent to which improper enrollments may have caused Medicaid overpayments,” the state comptroller said. “Under generally accepted government auditing standards, these restrictions would be considered an audit scope impairment.”

The comptroller said that during the course of the audit, it was not provided read-only access to the health eligibility system and was restricted from producing or observing pertinent queries, reports or data extractions. The health department told the comptroller that CSC was to build into the system necessary roles to allow secure access to certain information through a read-only mode, but many business functionalities, including read-only access, had been deferred to 2014 or later. As an alternative, when the comptroller sought specific health system data from the health department, it received only limited data extracts.


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