A new audit from State Comptroller Thomas DiNapoli has found that New York paid nearly $1.2 billion in Medicaid managed care premiums for people who may not have lived in the state.
Auditors said the state Department of Health (DOH) failed to properly verify residency for Medicaid enrollees and was slow to recover improper payments. The review covered July 2017 through October 2024.
“Medicaid is a vital program and the single biggest expense in the state budget. We cannot afford any wasteful spending,” DiNapoli said. “Stronger coordination is needed to reduce improper payments, protect the program’s integrity, and ensure New York is only paying Medicaid costs for its residents.”
The audit found:
- $509 million in premiums were paid for more than 155,000 members flagged by other data sources, such as U.S. Postal Service change-of-address records.
- $375 million went to members who appeared on federal Public Assistance Reporting Information System (PARIS) matches but were never reviewed by DOH.
- $299 million was tied to members whose eligibility was closed but premiums were not recovered, or whose cases were flagged but never officially ended.
Auditors also noted that DOH did not begin reviewing federal PARIS data until 2019—two years after it started submitting member information—and identified $1.5 billion in payments made during the unreviewed period.
Even when improper payments were identified, state officials sometimes missed opportunities to recoup them. The Office of the Medicaid Inspector General told auditors that regulatory limits may have prevented the recovery of up to $11.4 million.
DiNapoli’s office recommended DOH strengthen its residency checks, use additional data sources such as postal change-of-address information, and work with federal officials to improve the PARIS matching process.
In a response, DOH officials generally agreed with the findings and said they are already taking steps to address them, including exploring new data sources and improving coordination with the federal government
