On December 11, 2024, New York State Comptroller Thomas P. DiNapoli issued the following State Department and Agency audits.
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Department of Health: Medicaid Program – Overpayments for Medicare Part C Claims (2023-S-13)
Under Medicare Part C, private insurance companies administer Medicare benefits
through Medicare Advantage Plans. From a judgmental sample of 89 claims
identified as high-risk, totaling $1,325,452, from five hospitals, auditors
determined Medicaid made improper payments for 49 Part C claims (55%) totaling
$881,233. The improper payments occurred in part because hospitals
misinterpreted state regulations and billing guidelines, did not properly
submit Claim Adjustment Reason Codes on claims, or indicated Medicare Advantage
Plans did not cover services when they actually did. Auditors also found
improvements are needed to the Department of Health’s automated claims
processing and payment system to prevent incorrect payments.
Homes and Community Renewal (HCR) receives federal funding from the U.S.
Department of Housing and Urban Development (HUD) through the Housing Trust
Fund Corporation to administer the Section 8 Housing Choice Voucher Program
(HCV) and the Section 8 Performance-Based Contract Administration Program
across the state. HCV provides rental and homeownership assistance. A prior
audit, issued in March 2023, found that HCR was not fully utilizing its
HUD-authorized HCV vouchers or budget to help families in need of housing
assistance, HCR did not meet HUD’s voucher utilization threshold during any
year covered by the initial audit scope, and HCR could not fully reconcile its
HCV financial figures. HCR made progress in addressing the issues identified in
the initial audit report, implementing two recommendations and partially
implementing another (one recommendation was no longer applicable).
Medicaid recipients receive necessary durable medical equipment (DME, i.e.,
devices and equipment available on a monthly rental basis) as a benefit of the
Medicaid program. There are typically limits (or caps) on the number of monthly
rental payments. A prior audit, issued in April 2023, found about $1.5 million
in overpayments and $503,619 in questionable payments for DME rentals. DOH made
little progress in addressing the issues identified in the initial audit
report. For example, DOH had not formally determined whether it is efficient
and appropriate to require a cap on the number of rental payments for oxygen
equipment. Of the initial report’s seven audit recommendations, one was
partially implemented and six were not implemented.
Title II of the 1990 Americans with Disabilities Act (ADA) prohibits discrimination against individuals with a disability in all programs, activities, and services of public entities, such as the New York City Department of Parks & Recreation (Parks). A prior audit, issued in March 2023, found that Parks’ accessibility efforts were primarily focused on ensuring newly funded capital projects are ADA compliant, rather than removing identified barriers at existing facilities. In addition, the audit found that agency officials did not adequately monitor concession contractors to ensure they were complying with contractual obligations and other accessibility requirements, nor did Parks ensure that the facility accessibility information posted on its website was accurate and updated. Parks officials made some progress in addressing the issues identified in the initial audit report, partially implementing five recommendations and not implementing two.
In 2021, New York State enacted legislation that essentially creates a single repository of links to all State agency and authority financial literacy information and programs. The law required all agencies and authorities to initially provide relevant financial literacy-related education information to the Department of Financial Services (DFS). Those subject to the law are also required to send any updates, revisions, and new information to DFS annually for posting. A prior audit, issued in September 2022, found that, although each of the five agencies assessed was involved to some degree in financial literacy efforts and some collaboration existed, there didn’t appear to be a coherent strategy or plan to coordinate these efforts statewide, nor was there a shared understanding or definition of “financial literacy.” The agencies made progress in addressing the problems identified in the initial audit report, implementing four of the five recommendations.
The Governor’s Office of Storm Recovery (GOSR), which operates within the Housing Trust Fund Corporation, a component of Homes and Community Renewal (HCR), was established in June 2013 as a temporary agency to coordinate and direct statewide administration of the federal funds used for recovery and rebuilding efforts in storm-affected municipalities across the state. Auditors identified potential weaknesses in GOSR’s methods for determining applicant eligibility to receive assistance and in determining award amounts. There were also delays in redevelopment of some properties and weaknesses in GOSR’s practices related to both recapturing funds and handling uncollectible accounts. Though sample results cannot be projected to the related populations of the funded properties, the implications and significance of the findings warrant prompt and appropriate action to better manage the remaining open projects and to inform other HCR housing programs.
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