Key Facts

Timeline of the New York Medicaid Findings

According to <a href="https://www.gao.gov/products/gao-26-108694"> GAO’s April 2026 payment-integrity report</a>, 15 federal agencies reported approximately $186 billion in improper payments across 64 programs during fiscal year 2025. The estimate increased by $24 billion from fiscal year 2024.



Approximately $153 billion, or 82% of the total, consisted of overpayments. Nineteen programs reported improper-payment rate estimates of at least 10%, and six reported rates above 25%.



Medicare, Medicaid, the Earned Income Tax Credit, the Supplemental Nutrition Assistance Program, and the Shuttered Venue Operators Grant program accounted for 73% of the reported total.



The programs face different payment risks. Medicare and Medicaid process large volumes of medical claims. Tax-credit programs depend on accurate income and household information. Nutrition programs rely on current eligibility records. Grant programs must confirm that recipients qualify and use the money for approved purposes.



GAO’s $186 billion figure is a national improper-payment estimate. It does not provide a complete state-by-state allocation showing how much of the total passed through New York agencies, providers, or recipients.

Which Federal Programs Produce the Most Improper Payments?

An improper payment is money that should not have been paid, was paid in the wrong amount, went to an ineligible recipient, or lacked enough documentation to verify that the payment was correct.



According to the <a href="https://www.cms.gov/newsroom/fact-sheets/fiscal-year-2025-improper-payments-fact-sheet"> Centers for Medicare and Medicaid Services’ fiscal year 2025 fact sheet</a>, insufficient documentation accounted for 77.17% of Medicaid improper payments. The missing information may involve eligibility, provider records, billing support, or another requirement.



The main financial classifications used on this page are:



&#8211; Estimate: A calculated amount based on available data and a stated method



&#8211; Improper payment: Money paid incorrectly or without sufficient support



&#8211; Questioned cost: Spending an auditor identifies for additional examination



&#8211; Confirmed loss: An amount established through completed investigative or legal work



&#8211; Settlement: Money agreed upon to resolve a civil matter



&#8211; Restitution ordered: Money a court directs a defendant to repay



&#8211; Recovered: Money the government has collected, seized, or otherwise secured



These labels help taxpayers distinguish an audit finding from a criminal case. They also show whether an agency has merely identified a payment problem or has actually recovered the money.

What Counts as an Improper Payment?

The New York Department of Health administers the state Medicaid program. Its eMedNY system processes claims and issues payments to health-care providers.



According to the <a href="https://www.osc.ny.gov/state-agencies/audits/2026/06/17/medicaid-program-claims-processing-activity-april-1-2025-through-september-30-2025"> State Comptroller’s June 2026 claims-processing audit</a>, eMedNY processed nearly 331 million claims and paid providers almost $55 billion during the six months ending September 30, 2025.



Auditors identified more than $12.1 million in improper payments during that period.



The largest finding involved approximately $6.3 million in managed care premiums paid for members who had other comprehensive health insurance. Medicaid generally serves as the payer of last resort, which means another available insurer should usually pay before Medicaid.



Another $5.2 million involved claims containing inaccurate information about members’ other insurance coverage. Incorrect or outdated insurance records can cause Medicaid to pay claims that should have been assigned to another payer.



Auditors also found:



$342,115 in managed care newborn and maternity payments involving inaccurate information, including incorrect birth weights



$276,436 in inpatient and clinic claims that did not comply with Medicaid policies



14 providers connected to health-care criminal proceedings



According to the audit, 12 of the providers were removed from Medicaid. One remaining provider was referred for professional licensing review, and another was referred for medical conduct review.



By the end of the audit, the Department of Health had recovered nearly $3.4 million. That figure represents money collected, rather than an amount recommended for recovery.

What New York’s Medicaid Claims Audit Found

Medicaid relies on accurate information about a member’s eligibility and other health coverage. When a member has another comprehensive insurance policy, that insurer should generally pay first.



The process can break down when an insurer reports coverage late, a provider enters incomplete information, or agency databases are not updated promptly. At New York’s claim volume, small errors can grow into millions of dollars in improper payments.



Effective controls should compare Medicaid records with available private insurance data before payment. Claims carrying conflicting coverage information should be paused or reviewed. Agencies should also record why an exception was approved and whether the money was later recovered.



The June 2026 audit found that inaccurate insurance information caused Medicaid to pay premiums and claims that another insurer may have owed. Identifying the error after payment left the Department responsible for tracing recipients and recovering the money.

Why Other Insurance Information Matters

A separate <a href="https://www.osc.ny.gov/state-agencies/audits/2024/02/23/medicaid-program-improper-payments-drugs-without-federal-drug-rebate-agreement"> State Comptroller audit of Medicaid drug payments</a> examined payments for drugs associated with manufacturers that did not have required federal rebate agreements.



Auditors identified approximately $50.3 million in managed care encounter claims that required further review. That figure is a questioned cost. It is not a confirmed loss or recovery amount.



The audit recommended that the Department review the claims and determine the appropriate action. The record required the agency to decide which payments were allowable, which amounts could be adjusted, and which payments should be recovered.



Later audit work reported that rate adjustments could account for nearly $3.3 million connected to physician-administered drugs. A state oversight office also reported recovering approximately $9.29 million from 13 managed care plans.



Auditors did not receive enough supporting material to verify the entire reported recovery during their follow-up. Less than 1% of the original $50.3 million had been recovered through provider claim voids or classified as unrecoverable through other audit work.



The figures therefore remain in separate categories:



&#8211; $50.3 million in questioned claims



&#8211; Nearly $3.3 million potentially addressed through rate adjustments



&#8211; Approximately $9.29 million reported as recovered



&#8211; Less than 1% recovered through provider claim voids or addressed through other audit work



Keeping the figures separate prevents a questioned amount from being presented as a confirmed loss.

What Auditors Found in Medicaid Drug Claims

In its response included with the <a href="https://www.osc.ny.gov/state-agencies/audits/2026/06/17/medicaid-program-claims-processing-activity-april-1-2025-through-september-30-2025"> June 2026 Medicaid claims audit</a>, the Department of Health generally agreed with the audit recommendations and described actions taken to recover payments, remove providers, and improve claims controls.



The Department reported nearly $3.4 million recovered by the end of the audit. It also removed 12 providers from Medicaid and referred two others to the appropriate professional oversight offices.



The response shows action on part of the audit. The remaining record must show what happened to the unrecovered balance, how the two referrals were resolved, and whether updated insurance checks prevented the same errors from recurring.

The Institution’s Response

Stopping an improper payment before it leaves the program is usually easier than recovering it afterward. New York’s audits point to several controls that can reduce payment errors.



<h3 class="wp-block-heading">Verify eligibility before payment</h3>



Programs should confirm income, residency, insurance coverage, and other requirements before releasing benefits. Eligibility information must also be updated when a recipient’s circumstances change.



<h3 class="wp-block-heading">Screen providers before enrollment</h3>



Health programs should check professional licenses, ownership records, exclusions, criminal history where permitted, and relationships between providers before allowing them to bill.



<h3 class="wp-block-heading">Match records across systems</h3>



Medicaid information can be compared with insurance, tax, employment, licensing, death, and incarceration records when legally authorized. A conflict should trigger review before payment.



<h3 class="wp-block-heading">Flag unusual billing patterns</h3>



Automated systems can identify duplicate services, conflicting dates, impossible combinations, unusual billing volume, and claims another insurer should cover.



<h3 class="wp-block-heading">Separate recovery from recommendations</h3>



An audit finding, recommended recovery, restitution order, and collected payment are different events. Agencies should publish each amount separately and connect it to the original finding.



<h3 class="wp-block-heading">Publish enforcement outcomes</h3>



When a matter is referred, the public record should later show whether it was charged, convicted, declined, dismissed, or cleared.

How Can New York Prevent Similar Payments?

The New York State Comptroller publishes audits, management responses, and follow-up reports. Open Book New York provides additional information about state contracts and spending. Federal agencies publish national improper-payment figures, compliance reviews, and inspector general findings.



These records provide useful information, but they do not always connect neatly. A state audit may identify an improper payment without linking to the final recovery. An agency may promise a new control without publishing evidence that it worked. A federal report may provide a national figure without identifying New York’s share.



A complete public record should show:



&#8211; The responsible agency and program



&#8211; The fiscal or audit period



&#8211; Total payments and claims processed



&#8211; Improper-payment amount and rate



&#8211; Cause of the payment error



&#8211; Management response



&#8211; Corrective-action deadline



&#8211; Amount recommended for recovery



&#8211; Amount actually collected



&#8211; Referral and enforcement status



The denominator matters. The June 2026 audit found more than $12.1 million in improper payments within almost $55 billion paid during the six-month review period. Both figures are needed to understand the size of the finding.

What Can New York Taxpayers Access?

The national improper-payment framework appears in <a href="https://www.tpaction.com/california-how-much-does-federal-fraud-cost-taxpayers-under-democratic-government-programs/"> California: How Much Does Federal Fraud Cost Taxpayers Under Democratic Government Programs?</a>.



Related benefit-program risks appear in <a href="https://www.tpaction.com/pennsylvania-what-are-the-largest-fraud-risks-in-democratic-medicaid-and-public-benefit-policies/"> Pennsylvania: What Are the Largest Fraud Risks in Democratic Medicaid and Public-Benefit Policies?</a> and <a href="https://www.tpaction.com/minnesota-which-democratic-government-programs-are-most-vulnerable-to-fraud-and-abuse/"> Minnesota: Which Democratic Government Programs Are Most Vulnerable to Fraud and Abuse?</a>.



The <a href="https://www.tpaction.com/government-fraud-waste-and-corruption-the-plain-english-glossary/"> Government Fraud, Waste and Corruption Plain-English Glossary</a> explains the financial and legal categories used throughout the series.

How This Page Fits the Improper-Payments Series

New York’s Medicaid findings show why Arizona must compare eligibility and insurance information before paying claims, screen providers before enrollment, and report recoveries separately from suspected losses.



Arizona’s behavioral-health record involves the same distinctions. Total billing, suspected fraud, criminal charges, convictions, recovered money, and restitution represent different stages of the record. <a href="https://www.tpaction.com/arizonas-2-8-billion-medicaid-sober-living-fraud-timeline-oversight-failures-and-what-is-still-happening/"> Arizona’s Medicaid Sober-Living Fraud Timeline: Oversight Failures and What Is Still Happening</a> applies those categories to Arizona’s Medicaid investigations and court outcomes.

What this means for Arizona

New York’s Democratic-led government administered a Medicaid system in which auditors identified more than $12.1 million in improper payments during one six-month review period. Nearly $3.4 million was recovered, two provider matters were referred, and additional corrective-action and recovery records remained open as of September 2026.



This page documents New York Medicaid payment findings, recoveries, referrals, and oversight failures; it does not catalog every New York public-benefit program. Other states appear in <a href="https://www.tpaction.com/are-democrats-corrupt-what-the-public-record-shows-state-by-state/"> the record on Democratic-led governments</a>.

What this shows about Democratic governance

As of September 2026, New York’s public records do not provide one reconciled total showing how much of every Medicaid audit finding has been recovered.



The remaining records needed include:



The final recovery total for the June 2026 claims audit



Outcomes of the two professional oversight referrals



Documentation supporting the reported $9.29 million drug-claim recovery



Final decisions on the $50.3 million in questioned drug claims



Follow-up testing of other-insurance controls



State-level shares of federal improper-payment estimates



Final enforcement outcomes for pending provider cases



These records would show whether New York corrected the immediate payment errors and prevented the same problems from recurring.

What Is Still Open

Frequently Asked Questions

New York’s Medicaid audits show how inaccurate insurance data, weak claim checks, and incomplete recovery documentation can expose public money. During one six-month period, the state processed nearly 331 million claims and paid almost $55 billion. Auditors identified more than $12.1 million in improper payments.



Nearly $3.4 million had been recovered by the end of the audit. The remaining public record must show what happened to the balance, how provider referrals were resolved, and whether the Department’s corrective actions stopped the same errors.



The national figures make the stakes clear. Federal agencies estimated $186 billion in improper payments during fiscal year 2025, with Medicare, Medicaid, tax credits, nutrition benefits, and business assistance accounting for most of the total. New York’s findings show how those national risks can become state-level losses when eligibility, insurance, billing, and recovery controls fall behind.

The bottom line

Identifying an improper payment is only the beginning. New York taxpayers still need to know how much money was recovered, which referrals produced final action, and whether later audits confirmed that promised safeguards were working.



<a href="http://tpaction.com/Vote">Register to Vote</a>, <a href="https://www.tpaction.com/plan">make a plan to vote</a>, and <a href="https://www.tpaction.com/getinvolved">get involved</a> while continuing to review New York’s public audits, agency responses, and recovery records.

Follow New York’s Medicaid Money to the Final Outcome

<a href="https://www.gao.gov/products/gao-26-108694">U.S. Government Accountability Office, Payment Integrity: Agencies’ Estimated Improper Payments Increased to $186 Billion in Fiscal Year 2025, April 27, 2026</a>



<a href="https://www.cms.gov/newsroom/fact-sheets/fiscal-year-2025-improper-payments-fact-sheet">Centers for Medicare and Medicaid Services, Fiscal Year 2025 Improper Payments Fact Sheet</a>



<a href="https://www.osc.ny.gov/state-agencies/audits/2026/06/17/medicaid-program-claims-processing-activity-april-1-2025-through-september-30-2025">New York State Comptroller, Medicaid Program: Claims Processing Activity April 1, 2025 Through September 30, 2025, June 17, 2026</a>



<a href="https://www.osc.ny.gov/state-agencies/audits/2024/02/23/medicaid-program-improper-payments-drugs-without-federal-drug-rebate-agreement">New York State Comptroller, Medicaid Program: Improper Payments for Drugs Without a Federal Drug Rebate Agreement, February 23, 2024</a>

Sources

See which programs drive improper payments in New York, what auditors found, how much was recovered, and where stronger oversight is still needed.

New York: What Are the Biggest Sources of Improper Payments in Democratic Government Programs?

Key Facts

Timeline of the New York Medicaid Findings

Which Federal Programs Produce the Most Improper Payments?

What Counts as an Improper Payment?

What New York’s Medicaid Claims Audit Found

Why Other Insurance Information Matters

What Auditors Found in Medicaid Drug Claims

The Institution’s Response

How Can New York Prevent Similar Payments?

What Can New York Taxpayers Access?

How This Page Fits the Improper-Payments Series

What this means for Arizona

What this shows about Democratic governance

What Is Still Open

Frequently Asked Questions

Is this an example of Democratic corruption?

Which programs produce the most improper payments?

How much did New York’s Medicaid claims audit identify?

How much money had New York recovered?

Are all improper Medicaid payments fraud?

The bottom line

Follow New York’s Medicaid Money to the Final Outcome

Sources

RioSlum Studio

New York: What Are the Biggest Sources of Improper Payments in Democratic Government Programs?

Key Facts

Timeline of the New York Medicaid Findings

Which Federal Programs Produce the Most Improper Payments?

What Counts as an Improper Payment?

What New York’s Medicaid Claims Audit Found

Why Other Insurance Information Matters

What Auditors Found in Medicaid Drug Claims

The Institution’s Response

How Can New York Prevent Similar Payments?

What Can New York Taxpayers Access?

How This Page Fits the Improper-Payments Series

What this means for Arizona

What this shows about Democratic governance

What Is Still Open

Frequently Asked Questions

Is this an example of Democratic corruption?

Which programs produce the most improper payments?

How much did New York’s Medicaid claims audit identify?

How much money had New York recovered?

Are all improper Medicaid payments fraud?

The bottom line

Follow New York’s Medicaid Money to the Final Outcome

Sources