The audit looked at claims for patients who are both Medicare and Medicaid eligible, which are known as crossover claims. In December 2009, the Department of Health implemented a new payment mechanism in eMedNY to achieve greater control over Medicaid payments. The new mechanism is an attempt to ensure Medicaid does not pay crossover claims denied by Medicare, only pays the portion of the claim that it actually owes and crossover claims are billed first to Medicare before being billed to Medicaid.
DiNapoli’s auditors found that from implementation of the new system in 2009 through March 31, 2012, the system was not working correctly, allowing nearly 866,000 improper and questionable payments to be made. Auditors identified $6.9 million that eMedNY improperly paid for, including 137,000 crossover claims previously denied by Medicare. Auditors also identified $3.1 million for 277,000 crossover claims where the payment exceeded the amount that Medicaid owed. In addition, auditors found that more than 24,800 providers were able to bypass crossover system controls and bill approximately 452,000 claims directly to Medicaid instead of first billing Medicare. As a result, Medicaid made potential overpayments totaling $16.4 million. Since December 3, 2009, Medicaid reimbursed a total of $1.1 billion for approximately 41.4 million crossover claims.
DiNapoli’s auditors recommended that the DOH:
Office of Children and Family Services, Oversight of Child Protective Services Outside New York City (Follow-Up) (2011-F-19)
Division of Housing and Community Renewal, Housing Preferences for Disabled Veterans (Follow-Up) (2012-F-21)
One employee at the College of Optometry had travel costs totaling $116,828. The selected employee was responsible for arranging travel for other college staff members, charging these travel expenses to his travel card. The expenses were documented and generally adhered to state travel rules and regulations. However, auditors found one instance where SUNY Optometry paid $9,000 to the Intrepid Museum Foundation for an event that was not related to travel. SUNY Optometry travel guidelines states that such payments are not permissible. A college official told auditors the card was uses only as a contingency because the vendor had not received the check issued for payment.
An employee at SUNY Purchase and incurred lodging costs totaling $991,999. Auditors found the employee was responsible for arranging overflow student housing at local hotels each fall semester when on campus housing was exhausted, charging these expenses to her procurement card. Housing students at local hotels has been the practice since 2002. The expenses were appropriately approved and documented. However, College management has not conducted a formal written study to examine the options for alleviating the student housing shortage and to ensure the most efficient use of state funds.