Click on the text highlighted in color to access the audit posted on the Internet.
Department of Health – Medicaid Program: Improper Medicaid Payments to Hospitals for Outpatient Services Billed as Inpatient Services for Recipients Enrolled in Managed Care (Follow-Up) (2026-F-1) When managed care enrollees receive care at hospitals, managed care organizations (MCOs) reimburse the hospitals, and a recipient’s hospital status—inpatient versus outpatient—affects Medicaid’s reimbursement. A prior audit, issued in August 2024, examined whether Medicaid made improper payments to hospitals for outpatient services billed as inpatient services for recipients enrolled in managed care with a focus on inpatient claims with patient stays of less than 24 hours (“short-stays”). The audit found that the Department of Health (DOH) did not review short-stay inpatient encounters or provide guidance to MCOs and hospitals on how to determine whether a short-stay claim should be billed as inpatient or outpatient. DOH officials made little progress in addressing the problems identified in the original audit report. Of the initial report’s four audit recommendations, one was implemented and three were not. implemented.
Department of Health – Medicaid Program: Improper Payments for Laboratory and Related Services (2023-S-51) The Department of Health (DOH) and managed care organizations (MCOs) can set limits on laboratory procedures, such as daily, weekly, yearly or per lifetime. These limits are enforced in MCOs’ claim processing systems and in eMedNY (the Medicaid claim processing and payment system) through system edits but can be exceeded for medical necessity. For the period from June 2019 through January 2025, auditors found $21.6 million in payments due to DOH not providing adequate guidance to providers and MCOs and not effectively monitoring claims for certain laboratory procedures, as well as weaknesses in the eMedNY system edits.
Office for People With Developmental Disabilities – Incentives for Non-Profit Service Providers’ Recruiting and Retention Efforts (2023-S-44) The Office for People With Developmental Disabilities (OPWDD) coordinates services for individuals directly through its 13 Developmental Disabilities Services Offices, and through a network of over 500 non-profit service providers (Providers). To address significant staff shortages that caused many Providers to close programs or reduce operations, OPWDD issued bonuses and supplemental one-time payments to help Providers retain and recruit direct support professionals, utilizing federal funding through the American Rescue Plan Act and enacting State budget cost‑of‑living adjustments. Auditors identified certain weaknesses in OPWDD’s oversight of various incentive payments, which resulted in inconsistent distribution of these payments to direct support professionals, potentially working counter to the bonus and incentive programs’ intention to retain and recruit this critical workforce sector.
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, 2025 (2025-M-3) 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, 2025 totaled $32.4 million.
Nelson A. Rockefeller Empire State Plaza Performing Arts Center Corporation – Security Over Critical Systems (2025-S-37) The Nelson A. Rockefeller Empire State Plaza Performing Arts Center Corporation operates the performing arts center housed within The Egg, which is part of the Nelson A. Rockefeller Empire State Plaza complex in Albany. The Egg utilizes 11 systems to support its network and operations. The Egg is subject to New York State Office of Information Technology Services policies and standards under Executive Order 117. To process credit cards, The Egg must follow the Payment Card Industry Data Security Standard. Auditors identified areas where The Egg could improve security controls to minimize risks associated with unauthorized access to its systems and data and communicated the details of these findings in a confidential report to Egg officials.
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