New York Paid $14.5 Billion Medicaid Claims Unverified
State auditors found Medicaid home care payments went out without confirming patients received the billed services.
Updated on Nov. 6, 2026 in Healthcare
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New York paid $14.5 billion in Medicaid claims without verification that patients received the billed care. The state had a system feature designed to block claims lacking a matching electronic visit verification record but did not activate it.
Why it matters
The findings point to gaps in how New York confirms that taxpayer-funded home care is actually delivered. Other states have moved to tighten verification, raising questions about whether New York will follow.
Nearly $10 million went to home care visits billed during patient hospitalizations, and nearly $12 million to visits lasting under eight minutes. About $1.2 billion in premiums went to people living outside New York.
The players
New York State Office of the State Comptroller
The state's independent fiscal watchdog, which audits state agencies and programs including Medicaid spending.
Missouri
A state that has begun automatically denying certain Medicaid claims that lack matching verification records.
The details
Federal rules require Medicaid claims for certain home care services to carry a matching electronic visit verification record. New York had a system feature that would block claims without one, but did not turn it on. Address changes for more than 155,000 people accounted for over $500 million in costs, and another $375 million was tied to the state not reviewing federal matching data.
Timeline
Only a little over half of New York care was verified during the period reviewed by the state comptroller's office.
Missouri began automatically denying some claims this spring.
Market Landscape
The federal electronic visit verification requirement for Medicaid home care sets a shared standard, and states are now enforcing it at different strengths. Missouri and Texas have moved to reject mismatched claims while New York left its blocking feature off.
Medicaid enrollees receiving home care may see tighter verification of their visits and provider records as states enforce electronic checks. Providers billing New York Medicaid could face more claim denials if the blocking feature is later activated.
The takeaway
Verification gaps in public health spending leave both taxpayers and patients exposed, and the states that enforce matching records are already catching mismatches. New York's unused safeguard shows how much oversight depends on switches being turned on.
Further reading
For broader coverage of how states manage health spending, see Healthcare reporting.
Source note: This article includes information reported by The National Desk.
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