New York State Comptroller Thomas P. DiNapoli announced today the following audits have been issued.

New York State Dental Insurance Program – EmblemHealth Plan, Inc. – Overpayments for Services Requiring Coordination of Benefits (2022-S-27) 

The Department of Civil Service contracts with EmblemHealth Plan, Inc. (Emblem) to process and pay claims for services on behalf of the New York State Dental Insurance Program. To prevent duplicate payment of services, health insurance companies use a process called coordination of benefits for paying health care claims when an individual is covered by more than one insurance plan. Auditors identified $492,061 in overpayments for services processed with coordination of benefits for the audit period, January 2018 through October 2022, because Emblem failed to correctly coordinate benefits with each member’s other subscriber plan.

Department of Health – Medicaid Program – Recovering Managed Care Overpayments for Pharmacy Services on Behalf of Recipients With Third-Party Health Insurance (Follow-Up) (2023-F-27) 

Many of the State’s Medicaid recipients receive their services through managed care and also have other third-party health insurance. Managed care organizations (MCOs) are required to coordinate benefits with recipients’ third-party health insurance prior to paying for Medicaid services. The Office of the Medicaid Inspector General (OMIG) contracts with Health Management Systems, Inc. (HMS) to identify and recover Medicaid payments that should have been paid for by third-party health insurance. A prior audit, issued in July 2022, determined that the Department of Health (DOH) and OMIG lacked adequate oversight of the third-party liability recovery process. HMS had not billed third-party health insurance carriers for the recovery of about $292 million in pharmacy claims that MCOs paid as the primary insurance for recipients who, according to the Medicaid claims processing system, had third-party health insurance drug coverage. The follow-up found that, of the initial report’s six audit recommendations, three were partially implemented and three were not implemented.

Department of Motor Vehicles – Assessable Expenses of Administering the Motor Vehicle Financial Security Act and the Motor Vehicle Safety Responsibility Act for the State Fiscal Year Ended March 31, 2023 (2023-M-1)

The Motor Vehicle Financial Security Act and the Motor Vehicle Safety Responsibility Act help ensure that the operators of motor vehicles driven in New York State possess adequate insurance coverage, or are financially secure, to compensate those persons they might injure or whose property they might damage as a result of an accident. The Department of Motor Vehicles is responsible for tracking the expenses of administering the acts and assessing these expenses on insurance carriers that issue policies or contracts of automotive bodily injury insurance. Auditors found that the expenses for administering the acts for the State Fiscal Year ended March 31, 2023 totaled $25.5 million.

New York Racing Association – Purchasing and Procurement Practices (Follow-Up) (2023-F-31) 

The New York Racing Association, Inc. (NYRA), a not-for-profit corporation that holds the exclusive franchise rights to operate New York State’s three major thoroughbred racetracks, entered into a bankruptcy settlement agreement in September 2008, conveying all rights, titles, and interests in its racetracks to the State. In return, the State forgave nearly all of NYRA’s debt obligations and a Franchise Oversight Board was established to oversee NYRA’s financial operations. A prior audit, issued in March 2022, found that NYRA needed to improve its monitoring and oversight of its purchasing and procurement process to promote sufficient competition. The follow-up found that of the initial report’s eight audit recommendations, three were implemented, two were partially implemented, and three were not implemented.

New York City Department of Education – Compliance With School Safety Planning Requirements (Follow-Up) (2022-F-32) 

The New York State Safe Schools Against Violence in Education (SAVE) Act was signed into law in 2000 to promote a safer and more effective learning environment within State schools. Further, the Education Law requires schools and school districts to take safety planning actions and the State Education Department Commissioner’s Regulations and DOE Chancellor’s Regulations provide additional guidance. For example, the New York City Department of Education’s (DOE) District Safety Team must develop a comprehensive district-wide school safety plan and DOE’s schools must develop school-specific emergency response plans. A prior audit, issued in June 2019, determined that DOE could improve its compliance with the school safety planning requirements. The follow-up found that, of the initial report’s 19 recommendations, nine were implemented, four were partially implemented, and six were not implemented.

New York City Department of Buildings – Oversight of Building Construction Site Safety (Follow-Up) (2023-F-32) 

The New York City Department of Buildings (DOB) is responsible for regulating the safe and lawful use of buildings and construction sites to promote the safety of all people who visit, live, and work in NYC. A prior audit, issued in September 2022, found that DOB’s oversight of building construction sites and enforcement activity needed to be improved to ensure that responsible parties report all building construction site incidents and comply with codes, rules, and regulations. Additionally, DOB’s enforcement activities provided limited assurance that immediately hazardous conditions identified by DOB were being addressed in a timely manner. The follow-up found that, of the initial report’s six recommendations, two were implemented, one was partially implemented, and three were not implemented.

New York City Department of Social Services – New York City Department of Homeless Services – Oversight of Contract Expenditures of Samaritan Daytop Village, Inc. (2022-N-6) 

The New York City Department of Homeless Services (DHS), a unit of the New York City Department of Social Services (DSS), is responsible for providing transitional housing and services for eligible homeless families and individuals in New York City (City) and for providing fiscal oversight of the homeless shelters. In July 2013, DHS contracted with Samaritan, a City-based not-for-profit organization, to provide services for men with mental illness at their 160-bed Myrtle Avenue Men’s Shelter (Myrtle) for the period from August 2013 to June 2018. To qualify for reimbursement, Samaritan’s expenses must comply with the DHS Human Service Providers Fiscal Manual, the New York City Health and Human Services Cost Policies and Procedures Manual, and the Myrtle contract. The audit found that DHS is not effectively monitoring its contract with Samaritan to ensure reported costs are allowable, supported, and program related. For the two fiscal years ended June 30, 2021, auditors identified $566,556 that did not comply with requirements.