New York State Comptroller Thomas P. DiNapoli announced today the following audits have been issued.
Department of Health – Medicaid Program – Excessive Payments for Durable Medical Equipment Rentals (2021-S-36)
Medicaid recipients receive necessary durable medical equipment (DME) – wheelchairs, for example – as a benefit of the program. Some DME items are available on a monthly rental basis, subject to caps; when the cap is reached, the item is generally considered purchased and no additional rental payments are made. However, certain other DME, such as oxygen equipment, is available for continuous (i.e., uncapped) rental only. Auditors identified Medicaid overpayments totaling nearly $1.5 million for DME rentals that exceeded established monthly caps. In addition, noting that Medicare imposes a 36-month cap on oxygen equipment rental payments, auditors determined that Medicaid could achieve significant cost savings – including an estimated $8.6 million for the audit scope – if the Department of Health adopted a similar policy rather than allowing continuous uncapped rentals of DME.
Metropolitan Transportation Authority – Long Island Rail Road – Non-Revenue Service Vehicles and On-Rail Equipment (2020-S-29)
The Long Island Rail Road (LIRR) has an inventory of 1,034 fleet vehicles – cars, SUVs, trailers, trucks, and vans – used by 26 departments in their day-to-day operations. It also maintains 43 pieces of on-rail equipment, with an estimated cost of almost $57 million, and a parts inventory consisting of 9,373 different part numbers/types valued at over $10.2 million. Auditors determined that LIRR did not ensure that its responsible departments were maintaining accurate inventories of these valuable assets, following procurement best practices, and/or providing the necessary preventive maintenance.
Department of Health – Medicaid Program – Improper Fee-for-Service Pharmacy Payments for Recipients With Third-Party Health Insurance (2021-S-20)
Where Medicaid recipients have other third-party health insurance (TPHI), such as Medicare or commercial health insurance, TPHI is the primary payer and Medicaid is the payer of last resort. The Office of the Medicaid Inspector General (OMIG) contracts with Gainwell Technologies (Gainwell) to identify claims where Medicaid was incorrectly identified as the primary payer and to recover payments. Auditors found that the Department of Health and OMIG did not ensure that Gainwell properly identified and recovered all Medicaid payments for fee-for-service pharmacy claims where TPHI was liable instead, identifying more $37.4 million in improper Medicaid payments that had not been pursued for recovery. Much of this amount may be unrecoverable due to New York State’s 3-year statute of limitations.
Department of Corrections and Community Supervision – Controls Over Tablet and Kiosk Usage by Incarcerated Individuals (2022-S-8)
The Department of Corrections and Community Supervision’s (DOCCS) tablet program provides incarcerated individuals with access to digital content (e.g., e-books, music) and messaging/ communication functionality. Tablet program assets included about 26,500 active tablets and 1,100 active kiosks across 44 facilities. Although DOCCS established Directives that govern the tablet program and address the secure use of devices, auditors found that DOCCS exerts little control over the tablet program to ensure that the Directives are enforced. Thus, there is limited assurance that tablets are being used appropriately and only by the individuals to whom they are assigned; that tablets and kiosks are secure and functioning as intended; and that incoming and outgoing communications with the outside community as well as within and across facilities are appropriately restricted. DOCCS also is not adequately overseeing the security and configuration of certain assets, and does not ensure systems are maintained at vendor-supported levels required to preserve the accuracy and integrity of its data.
Department of Health – Medicaid Program Claims Processing Activity April 1, 2022 Through September 30, 2022 (2022-S-12)
During the 6-month period ended September 30, 2022, eMedNY processed over 224 million claims, resulting in payments to providers of nearly $38 billion. OSC’s audit of Medicaid claims processing activity identified over $16.7 million in improper Medicaid payments for claims that were not processed in accordance with Medicaid requirements. The audit also identified 11 providers in the Medicaid program who were charged with or found guilty of crimes that violated laws or regulations governing certain health care programs. The Department of Health removed three of the providers from the Medicaid program and referred two to the New York State Office of the Attorney General’s Medicaid Fraud Control Unit; the remaining six providers were under the Office of the Medicaid Inspector General’s review.
Department of Health – Medicaid Program – Improper Payments of Medicare Buy-in Premiums for Ineligible Recipients (Follow-Up) (2022-F-37)
Medicaid pays premiums for individuals enrolled in the Medicare Buy-in Program. A prior audit report, issued in November 2021, identified $31.7 million in improper premium payments made on behalf of individuals who were not eligible for the Buy-in Program, an additional $23.6 million in payments made on behalf of individuals with coverage that exceeded Medicaid’s 2-year premium liability, and $372,716 in premium payments made on behalf of 282 individuals who were deceased but not disenrolled. The follow-up found that the Department of Health made some progress in addressing the problems identified; however, additional actions are needed. Of the initial report’s five audit recommendations, two were implemented, two were partially implemented, and one was not yet implemented.
Department of Transportation – Controls Over Vehicle Use and Transportation-Related Expenses (Follow-Up) (2022-F-38)
The Department of Transportation (DOT) maintains a fleet of 4,086 registered State-owned and 668 leased vehicles. In addition to its 10 regional repair shops responsible for vehicle maintenance, DOT also uses a centralized procurement contract (Contract), negotiated and entered into on behalf of the State by the Office of General Services, for fleet management and repair services. The initial audit, issued in July 2021, found that DOT performed limited to no monitoring of procurements made through the Contractor to ensure costs were reasonable, despite concerns raised by central office and regional office personnel. DOT also did little to hold the Contractor accountable for its responsibility to ensure costs complied with Contract terms. The audit also identified deficiencies in DOT’s controls over recalls and warranties and its oversight of fuel and mileage, which increased the likelihood that State funds were not being used efficiently and effectively and, in the case of open recalls, posed safety risks. The follow-up found that DOT made progress in addressing the issues previously identified. Of the initial report’s five recommendations, four were implemented and one was not implemented.
Port Authority of New York and New Jersey – Selected Aspects of Accommodations for Passengers With Disabilities (Follow-Up) (2022-F-24)
The Port Authority of New York and New Jersey (PANYNJ) is required to make its facilities accessible to passengers with disabilities, pursuant to the Americans with Disabilities Act of 1990 and the Rehabilitation Act of 1973. The initial report, issued in July 2021, identified deficiencies and non-compliance with the regulations in areas of the Port Authority Bus Terminal – the nation’s busiest bus terminal, serving an estimated 260,000 passenger trips per day. For example, some of the gates were inaccessible to customers using a mobility device both at the lower and upper levels, and no signage was evident to direct customers where to seek assistance. The follow-up found that PANYNJ made progress in addressing the issues identified. Of the initial seven recommendations, five were implemented and two were partially implemented.
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