New York State Comptroller Thomas P. DiNapoli announced today the following audits have been issued.
Department of Civil Service: New York State Health Insurance Program – Payments by CVS Health for Pharmacy Services for Ineligible Members (2020-S-17)
From Jan. 1, 2014 through Dec. 31, 2019, auditors identified 132,051 claims, totaling $30,695,221, that were paid for pharmacy services provided during periods when members were not eligible. Further, Civil Service paid CVS Health $170,359 in administrative fees for processing these claims.
Department of Civil Service: New York State Health Insurance Program – Payments by UnitedHealthcare for Medical/Surgical Services for Ineligible Members (2020-S-34)
Auditors identified $5.7 million that United paid for members who were not eligible for Empire Plan coverage. The improper payments occurred because the member was retroactively disenrolled ($4.6 million), or the claims were paid for services that occurred either before a member was enrolled or after United was notified the member was disenrolled ($1.1 million).
State Board of Elections (BOE): Use of Federal Funding for Election Technology and Security (2020-S-18)
Generally, the BOE has utilized available funding from its Help America Vote Act Election Security Grant to enhance the state’s election technology and infrastructure. Specifically, the BOE has planned for and spent funds for the activities described in its cybersecurity plan. Although a portion of the funds remains unspent as of February 2021, the BOE has designated the remaining funds for ongoing, multi-year initiatives that continue to address constantly evolving cybersecurity threats and enhance election infrastructure and security.
Department of Health (DOH): Oversight of Registration, Licensing, and Inspection of Radioactive Materials (RAM) Facilities and Radiation Equipment Facilities (2019-S-64)
DOH completed 94% of RAM facility and radiation equipment facility inspections on time; however, it completed 44% of those inspections beyond the established 1- to 5-year inspection time frames by relying on a buffer intended to allow for more flexibility and extensions to the inspection intervals for staff time and travel. DOH did not complete all license actions within its 1-year benchmark. For example, as of July 20, 2020, DOH had not completed 55 licensing actions that were beyond the 1-year benchmark. This could potentially jeopardize the quality of the department’s licensing program, which can have a direct bearing on public health and safety, as well as security.
Department of Health (DOH): Medicaid Program – Claims Processing Activity April 1, 2020 Through Sept. 30, 2020 (2020-S-22)
The audit identified over $9.7 million in improper Medicaid payments that require DOH’s prompt attention, including: $4.5 million paid for an incorrect retroactive rate adjustment; and $2.1 million paid for inpatient claims that were billed at a higher level of care than what was actually provided. By the end of the audit fieldwork, about $6.8 million of the improper payments had been recovered.
Department of Health: Medicaid Program – Cost Saving Opportunities on Payments of Medicare Part C Claims (2020-S-65)
New York’s current Medicaid payment rules for Medicare Part C cost-sharing liabilities compared to the allowable alternatives have significantly different costs to the Medicaid program. If New York Medicaid had limited its cost-sharing so that the total payment (Medicare’s payment plus what Medicaid was billed for the copayment or coinsurance) was no more than the typical Medicaid fee, it could have saved over $419 million from July 1, 2016 to Dec. 31, 2020. Other states already use this approach, and it is similar to how New York Medicaid currently pays Medicare Part B cost-sharing. Using this reimbursement formula, auditors estimate the state could save over $122 million annually.
For the period of July 2012 through July 2018, SED made 216 advance payments totaling $546,625 to 113 contractors whose 25 percent advance payment was the only expenditure made under the contract prior to its expiration. These contacts had a total value of nearly $2.2 million. Auditors selected 13 contracts valued at $224,000 ($56,000 in advance payments) for review and found SED did not obtain any reports from the 13 contractors documenting how the advance funds were expended. As a result, SED needed to improve its contract monitoring to ensure contractors expended advanced funds in accordance with the terms and conditions of the contracts.
State Education Department (SED): Westchester County Chapter NYSARC Inc. (WARC) – Compliance With the Reimbursable Cost Manual (2020-S-27)
WARC is an SED-approved, non-profit special education provider located in Westchester County, serving students from Westchester and Putnam counties. Among other programs, WARC provides preschool special education services to children with disabilities who are 3 and 4 years of age. WARC is reimbursed for these services through rates set by SED. For the fiscal year ended June 30, 2016, auditors identified $49,605 in ineligible costs reported by WARC for reimbursement.
Workers' Compensation Board: Assessment of Costs to Administer the Workers' Compensation Program for the Three State Fiscal Years Ended March 31, 2020 (2021-M-1)
Auditors performed certain procedures, which were agreed to by the board, to ascertain the expenses it incurred in administering the program for the three State Fiscal Years ended March 31, 2020. On average, the board incurred $207 million in expenses, including about $6 million attributable to administering self-insurance, to administer the program for each of the three years.
Office of General Services (OGS): Compliance With Executive Order 95 (Open Data) (Follow-Up) (2021-F-12)
An audit covering the period March 11, 2013 through Dec. 6, 2019 found OGS had taken steps to meet the requirements of EO 95; however, certain aspects of the order were not fully addressed and there was limited assurance OGS provided a complete catalogue of its publishable state data or accompanying schedules for making that data public, as required. In a follow-up, auditors found OGS made limited progress in addressing the problems identified in the initial audit report.
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