OIG Finds New York Made Unallowable Capitation Payments for Incarcerated Enrollees

The HHS Office of Inspector General determined that New York made unallowable managed care capitation payments on behalf of incarcerated Medicaid enrollees. Federal law prohibits federal Medicaid funding for services provided to incarcerated individuals, with limited exceptions for inpatient hospital care. The audit findings indicate the state made capitation payments to managed care organizations for enrollees who were incarcerated during the coverage period. OIG recommendations typically require states to refund the federal share of identified overpayments and implement corrective actions to prevent future unallowable payments.

Managed Care · Finance