由于系统缺陷和第三方索赔处理中的错误,纽约在医疗补助多付中发现1.7M美元。 
New York found $1.7M in Medicaid overpayments due to system flaws and errors in third-party claims processing.
纽约州审计发现,由于对第三方分担费用索赔监督不力,医疗援助计划多付了170万美元,其中1.775万美元与医疗援助计划处理错误有关,3 220美元与遗失文件有关。 A New York state audit found $1.7 million in Medicaid overpayments due to weak oversight of third-party cost-sharing claims, with $1.775 million linked to a processing error at a Medicare Advantage plan and $3,220 from missing documentation. 审计涉及2020年12月至2024年5月期间的索偿要求,发现电子MedNY系统存在系统性缺陷,包括没有防止提供方投入不准确的保障措施,也没有纠正索赔调整理由代码错误的权力,特别是第45号PR。 The audit, covering claims from December 2020 to May 2024, revealed systemic flaws in the eMedNY system, including no safeguards against inaccurate provider inputs and no authority to correct Claim Adjustment Reason Code errors, particularly PR 45. 卫生部承认在处理某些索赔方面存在混乱,正与医疗补助监察主任合作,审查近69 000件类似索赔,并加强监督。 The Department of Health admitted confusion over handling certain claims and is working with the Medicaid Inspector General to review nearly 69,000 similar claims and strengthen oversight.
