State Comptroller Thomas P. DiNapoli announced today the following audits have been issued.
Metropolitan Transportation Authority – New York City Transit: Risk Assessment and Implementation of Measures to Address Extreme Weather Conditions (2021-S-27)
Flooding remains a serious issue for the City and the Metropolitan Transportation Agency’s (MTA) transportation system, including New York City Transit (Transit). In September 2007, the Chair of the MTA appointed a commission to make sustainability-related recommendations to the MTA and its agencies. The audit found that, to date, the MTA has not implemented one of the most important recommendations – the development of the climate change adaptation master plan. Further, review of a sample of capital projects intended to correct or prevent damage found that projects were often incomplete in scope of work, not finished on time or within budget, or insufficiently documented.
Department of State – Implementation of the Security Guard Act (Follow-Up) (2023-F-20)
Article 7-A of the General Business Law, also known as the Security Guard Act (Act), requires that individuals working as security guards have a valid registration card and entrusts the Department of State (DOS) with issuing registration cards. The Act also requires guards to complete training and renew their registration every two years. A prior audit, issued in July 2021, found security guards classified as police/peace officers did not fulfill their training requirements, including armed guards who did not complete the required firearms training. The follow-up found DOS made significant progress in addressing the problems identified in the initial audit report, implementing a new procedure for monitoring and reviewing training records. Of the initial report’s four audit recommendations, three were fully implemented and one was partially implemented.
Department of Transportation – Compliance With Freedom of Information Law Requirements (2020-S-12)
The New York Freedom of Information Law (FOIL) provides for public access to government records. Under FOIL, agencies, including the Department of Transportation (DOT), must make all eligible records available for public inspection or copying upon request. The audit found DOT did not always comply with the FOIL requirements, identifying instances of non-compliance, including cases of DOT not providing the requested records available, denying the request, or failing to acknowledge the request within the statutory time frame. Furthermore, DOT obstructed the audit by, among other actions, requiring that all meetings be attended by supervisory staff from DOT’s main office and not providing all requested information.
New York Power Authority – Selected Management and Operations Practices: BuildSmart NY/Executive Order 88 (2023-S-27)
BuildSmart NY is a program created to carry out Executive Order 88 (EO 88), which mandated a 20% improvement in the energy efficiency performance of State government buildings by April 2020 and the BuildSmart 2025 program expands upon the original program and sets new objectives equivalent to a 34% reduction in energy usage. The New York Power Authority (NYPA) administers EO 88 and organizations subject to EO 88 (Affected State Entities [ASEs]) work with NYPA to achieve their allotted portion of the overall savings targeted by 2025. NYPA’s Final Report shows the actual reduction reported was 14.4% by April 2020, and when committed projects (incomplete) are added, the reduction is 22.6%. However, the report includes 123 projects of 158 that are not scheduled to be completed until as late as 2024. Additionally, when NYPA annually reported the status of the BuildSmart NY program, officials shied away from identifying the deficiencies in ASE non-compliance and instead asserted that they had no ability to enforce EO 88.
State Education Department – Adult Career and Continuing Education Services: Vocational Rehabilitation Supported Employment Program (Follow-Up) (2023-F-15)
The State Education Department’s (SED) Adult Career and Continuing Education Services – Vocational Rehabilitation (ACCES-VR) program provides vocational rehabilitation services for and supports the employment goals of people with a disability. To help program participants achieve and maintain employment, counselors develop an Individualized Plan for Employment (IPE) with each participant, which identifies the employment goal, services that will be provided to help achieve that goal, and how progress will be measured. A prior audit, issued in March 2022, found that SED did not always meet the time frames for eligibility determinations or finalization and annual reviews of IPEs and SED did not provide any documented evaluations to show the ACCES-VR program was being adequately monitored. The follow-up found SED made progress addressing the issues identified in the initial audit report, replacing its case management system to allow for improved oversight and developing step-by-step guidance for counselors completing IPEs. Of the initial report’s three recommendations, two were implemented and one was partially implemented.
State Education Department – Oversight of Mental Health Education in Schools (Follow-Up) (2023-F-21)
Under Section 804 of the Education Law (Law), the State Education Department (SED) is responsible for enforcing a requirement for mental health education in schools. An initial audit, issued in April 2022, found that mental health teams at many school districts were understaffed and that SED did not require school districts to submit any documentation indicating compliance with the Law. SED made progress in addressing the problems identified in the initial audit report, developing a mechanism to determine if schools are providing mental health education and taking steps to secure more mental health staffing. Both recommendations from the initial report were implemented.
New York City Office of Technology and Innovation – LinkNYC Program Revenues and Monitoring (Follow-Up) (2022-F-25)
New York City’s Office of Technology and Innovation (OTI) procures citywide IT services. In December 2014, NYC entered into a Franchise Agreement (Agreement) with a consortium of technology, media, and connectivity providers (Consortium) to replace aging public pay telephones with state-of-the-art connection points called Links that would offer free Internet access and phone service. A prior audit issued in July 2021 found that OTI did not sufficiently monitor and enforce the Consortium’s compliance with the Agreement terms, including the collection of almost $70 million due to NYC. The follow-up found that OTI made progress in addressing these issues, but it could do more to ensure revenues owed are assessed and collected correctly and Links are properly installed and maintained. Of the initial report’s 18 recommendations, seven were implemented, six were partially implemented, and five were not implemented.
Medicaid Program – Recovering Managed Care Payments for Inpatient Services on Behalf of Recipients With Third-Party Health Insurance (2021-S-24)
For Medicaid recipients enrolled in managed care, the Department of Health (DOH) pays managed care organizations (MCOs) a monthly premium for each enrolled recipient, and, in turn, the MCOs arrange for their health care services, including inpatient services. Many recipients have other third-party health insurance (TPHI) in addition to Medicaid. Medicaid is considered the payer of last resort, and, as such, MCOs are required to coordinate benefits with the recipient’s TPHI prior to paying for Medicaid services. The Office of the Medicaid Inspector General uses a contractor to identify and recover payments made for services that should have been paid for by a recipient’s TPHI. During the audit period, the contractor did not bill TPHI carriers or initiate provider reviews for the recovery of $52.2 million in inpatient claims where MCOs paid as the primary insurance despite recipients having TPHI inpatient coverage.
Department of Health: Medicaid Program – Improper Medicaid Payments for Claims Not in Compliance With Ordering, Prescribing, Referring, and Attending Requirements (Follow-Up) (2023-F-4)
As of January 1, 2014, New York’s Medicaid program required health care professionals who order, prescribe, refer, or attend (OPRA) Medicaid services be appropriately screened and enrolled in Medicaid and their National Provider Identifier (NPI) – a unique identification number – to be included on Medicaid claims. A prior audit issued in August 2021 found Medicaid made over $1.5 billion in improper and questionable payments for claims that did not contain an enrolled or affiliated OPRA NPI as required or where the NPI was not properly validated by the Department of Health (DOH) at the time of payment, and $19.4 million in payments for claims that contained an OPRA NPI that should not be included on Medicaid claims or that should be further reviewed by DOH due to past misconduct. The follow-up found that none of the improper and questionable payments have been reviewed. Furthermore, DOH has not improved system controls to prevent improper use of an override option for pharmacy claims that were denied because they did not contain the NPI of an enrolled provider in the prescribing field, and, as a result, auditors identified another $11.3 million in improper pharmacy payments since the initial audit. Of the initial report’s 12 audit recommendations, one was implemented, three were partially implemented, and eight were not implemented.
New York State Health Insurance Program – UnitedHealthcare Insurance Company of New York: Overpayments for Physician-Administered Drugs (2021-S-32)
The Department of Civil Service contracts with UnitedHealthcare Insurance Company of New York (United) to administer the Medical/Surgical Program of the Empire Plan, which covers a range of services, including physician-administered drugs, which are also covered under the Empire Plan’s separate Prescription Drug Program. A physician-administered drug is an outpatient drug (other than a vaccine) that is usually administered by a health care provider in a physician’s office or other outpatient clinical setting. The audit identified $5,536,537 in actual and potential overpayments for the cost of physician-administered drugs during the audit period. As of March 29, 2023, United recovered $254,188 of the improper payments.
New York State Health Insurance Program – Empire BlueCross: Overpayments for Physician- Administered Drugs (2021-S-33)
The Department of Civil Service contracts with Empire BlueCross (Empire) to administer the Hospital Program of the Empire Plan, which covers services including physician-administered drugs. A physician-administered drug is a drug, other than a vaccine, that is typically administered by a health care professional in a hospital or facility setting. In certain circumstances, physician-administered drugs are paid under the Empire Plan’s separate Prescription Drug Program, but both programs should not pay for the same physician-administered drug for the same patient on the same date of service. The audit identified $2,776,510 in actual and potential overpayments for the cost of physician-administered drugs during the audit period. As of June 21, 2023, Empire had started recoveries for $116,287 of the improper payments.
Department of Civil Service – New York State Health Insurance Program: Incorrect Payments by CVS Caremark for Medicare Rx Drug Claims That Were Improperly Paid Under the Commercial Plan (2022-S-24)
The Department of Civil Service contracts with CaremarkPCS Health, L.L.C. (CVS Caremark) to administer the prescription drug program for the Empire Plan, which includes the Empire Plan Medicare Rx drug plan (Medicare Rx Plan) for retired members and their dependents who have Medicare, and a Commercial Plan for members and their dependents who do not have Medicare. Claims paid under the Medicare Rx Plan are eligible for enhanced drug manufacturer discounts and federal subsidies that are not available for claims paid under the Commercial. For the audit period, auditors identified claims totaling $12,358,531 that were incorrectly paid under the Commercial Plan instead of the Medicare Rx Plan.