New York State Comptroller Thomas P. DiNapoli announced the following audits and reports were issued during the week ending December 1, 2016
Source: Office of the State Comptroller
Schusteritsch’s conviction comes after a joint investigation by the Office of the Comptroller and the Attorney General’s Office, which revealed that Schusteritsch stole over $180,000 in pension benefits issued by the New York State and Local Employees Retirement System to his deceased brother, Martin Petschauer, between July 2008 and September 2015.
When Petschauer died, Schusteritsch concealed his brother’s death from the bank and the Retirement System and kept the trust account open to maintain the direct deposits. He then routinely accessed the pension deposits and spent the money for his own benefit. All told, Schusteritsch stole over $180,000 in pension benefits until the Retirement System discovered Petschauer’s death in October 2015. Further, when the Retirement System learned of Petschauer’s death and stopped paying benefits into the trust account, Schusteritsch called the Retirement System’s call center on November 2, 2015, pretended he was Petschauer, and asserted that he was not actually dead, in an effort to maintain eligibility for the pension benefits.
Schusteritsch was sentenced by the Hon. Peter A. Lynch to six months in jail and five years’ probation, and signed a confession of judgment in the amount of $180,140.45 in favor of the New York State and Local Employees Retirement System on December 2, 12016.
“Those who illegally obtain pension funds intended for someone else do so at the expense of hardworking New Yorkers who rely on their pension for a secure retirement,” said Attorney General Schneiderman. “Comptroller DiNapoli and I will continue our joint efforts to root out pension system theft and hold those responsible accountable.”
Comptroller DiNapoli and Attorney General Schneiderman thanked the Charlotte County Sheriff’s Office in Florida for their assistance.
The Comptroller’s investigation was handled by the Division of Investigations working with the New York State and Local Retirement System.
The case was prosecuted by Assistant Attorney General Benjamin S. Clark of the Criminal Enforcement and Financial Crimes Bureau. The Criminal Enforcement and Financial Crimes Bureau is led by Bureau Chief Gary T. Fishman and Deputy Bureau Chief Stephanie Swenton.
The Attorney General’s investigation was conducted by Investigator Samuel Scotellaro, III and Deputy Chief Antoine Karam. Forensic accounting was performed by Meaghan Scovello, Associate Auditor. The Investigations Bureau is led by Chief Dominick Zarrella. The Forensic Audit Section is led by Chief Auditor Edward J. Keegan.
New York State Comptroller’s auditors identify Medicaid overpayments made to Medicare providers
New York State’s Medicaid system made approximately $6.8 million in inappropriate payments, including $3.5 million for separately billed medical services that should have been covered by managed care plans, according to an audit released by State Comptroller Thomas P. DiNapoli. By the end of audit fieldwork, about $2.4 million of the overpayments were recovered.
Additionally, auditors identified 15 Medicaid providers who were charged with or found guilty of crimes that violated the laws or regulations of a health care program. In addition, auditors found three providers who were involved in civil settlements. They advised DOH officials of the 18 providers and DOH terminated 14 of them from the Medicaid program. Another was also terminated from the program following the audit, according to DOH.
New York’s Medicaid program, administered by the State Department of Health (DOH), is a federal, state, and locally funded program that provides a wide range of medical services to those who are economically disadvantaged or have special health care needs. DOH’s eMedNY computer system processes Medicaid claims submitted by providers for services rendered to Medicaid-eligible recipients and generates payments to reimburse the providers for their claims.
DiNapoli’s office audits Medicaid payments on a routine basis to make sure claims are being paid appropriately and to determine if improvements are needed and whether money should be recovered because of errors, abuse or fraud. In 2015, DiNapoli’s auditors identified problems or irregularities with $223 million in payments.
DOH pays Medicaid providers through the fee-for-service method and the managed care plan method. Under the fee-for-service method, Medicaid pays health care providers directly for Medicaid-eligible services rendered to Medicaid recipients. Under the managed care plan method, Medicaid pays each managed care plan a monthly premium for each enrolled recipient and the plan arranges for the provision of services to its members. Plans typically have networks of participating health care providers that they reimburse directly for services provided to their enrollees. Generally, the costs of all services that plan enrollees require are covered by monthly premiums.
DOH uses eMedNY to make Medicaid payments to participating health care providers and managed care plans. The system is used to determine whether claims are eligible for reimbursement. For example, eMedNY will deny fee-for-service claims for services that are covered by a recipient’s managed care plan.
DiNapoli’s audit identified $3,521,562 in overpayments for 14,983 fee-for-service clinic claims that were inappropriate. The claims were processed on behalf of 3,504 recipients who were enrolled in a particular managed care plan. Auditors determined the services were covered by the plan and therefore, fee-for-service claims should not have been paid. A data entry error in eMedNY allowed clinic services for enrollees of this plan to be processed as fee-for-service. After being alerted to the issue, DOH immediately updated eMedNY to prevent future inappropriate payments.
DiNapoli’s auditors also found:
· $937,424 in overpayments for newborn claims that were submitted with incorrect birth weights;
· $389,813 in improper payments for inpatient, clinic, durable medical equipment, transportation, and eye care services;
· $333,504 in improper payments identified by the Centers for Medicare & Medicaid Services that DOH did not recover from providers;
· $260,330 in overpayments for inpatient claims that were billed at a higher level of care than what was actually provided; and
· $50,767 in improper payments for duplicate billings.
DOH officials generally agreed with the audit recommendations and indicated that certain actions have been and will be taken to address them. DOH’s full response is included in the complete audit.
Read the report, or go to: http://www.osc.state.ny.us/audits/allaudits/093017/15s74.pdf
State Education Department (SED): The Child Development Council Inc., Compliance with the Reimbursable Cost Manual (2016-S-22)
State Education Department: Rochester Childfirst Network, Compliance with the Reimbursable Cost Manual (2016-S-15)
State Education Department: Susan E. Wagner Preschool, Compliance with the Reimbursable Cost Manual (2015-S-100)