New
York State Comptroller Thomas P. DiNapoli
announced the audits and reports listed below were issued during
the week ending May 19,
2023
Links
to material posted on the Internet are highlighted in COLOR.
Department of Health – Medicaid Program – Excessive
Payments for Durable Medical Equipment Rentals (2021-S-36) Medicaid
recipients receive necessary durable medical equipment (DME) – wheelchairs, for
example – as a benefit of the program. Some DME items are available on a
monthly rental basis, subject to caps; when the cap is reached, the item is
generally considered purchased and no additional rental payments are made. However,
certain other DME, such as oxygen equipment, is available for continuous (i.e.,
uncapped) rental only. Auditors identified Medicaid overpayments totaling
nearly $1.5 million for DME rentals that exceeded established monthly caps. In
addition, noting that Medicare imposes a 36-month cap on oxygen equipment
rental payments, auditors determined that Medicaid could achieve significant
cost savings – including an estimated $8.6 million for the audit scope – if the
Department of Health adopted a similar policy rather than allowing continuous
uncapped rentals of DME.
Metropolitan Transportation Authority – Long Island Rail
Road – Non-Revenue Service Vehicles and On-Rail Equipment (2020-S-29)
The Long Island Rail Road (LIRR) has an inventory of 1,034 fleet vehicles –
cars, SUVs, trailers, trucks, and vans – used by 26 departments in their
day-to-day operations. It also maintains 43 pieces of on-rail equipment, with
an estimated cost of almost $57 million, and a parts inventory consisting of
9,373 different part numbers/types valued at over $10.2 million. Auditors determined
that LIRR did not ensure that its responsible departments were maintaining
accurate inventories of these valuable assets, following procurement best
practices, and/or providing the necessary preventive maintenance.
Department of Health – Medicaid Program – Improper
Fee-for-Service Pharmacy Payments for Recipients With Third-Party Health
Insurance (2021-S-20) Where Medicaid recipients have other
third-party health insurance (TPHI), such as Medicare or commercial health
insurance, TPHI is the primary payer and Medicaid is the payer of last resort.
The Office of the Medicaid Inspector General (OMIG) contracts with Gainwell
Technologies (Gainwell) to identify claims where Medicaid was incorrectly
identified as the primary payer and to recover payments. Auditors found that
the Department of Health and OMIG did not ensure that Gainwell properly
identified and recovered all Medicaid payments for fee-for-service pharmacy
claims where TPHI was liable instead, identifying more $37.4 million in
improper Medicaid payments that had not been pursued for recovery. Much of this
amount may be unrecoverable due to New York State’s 3-year
statute of limitations.
Department of Corrections and Community Supervision –
Controls Over Tablet and Kiosk Usage by Incarcerated Individuals (2022-S-8)
The Department of Corrections and Community Supervision’s (DOCCS) tablet
program provides incarcerated individuals with access to digital content (e.g.,
e-books, music) and messaging/ communication functionality. Tablet program
assets included about 26,500 active tablets and 1,100 active kiosks across 44
facilities. Although DOCCS established Directives that govern the tablet
program and address the secure use of devices, auditors found that DOCCS exerts
little control over the tablet program to ensure that the Directives are enforced.
Thus, there is limited assurance that tablets are being used appropriately and
only by the individuals to whom they are assigned; that tablets and kiosks are
secure and functioning as intended; and that incoming and outgoing
communications with the outside community as well as within and across
facilities are appropriately restricted. DOCCS also is not adequately
overseeing the security and configuration of certain assets, and does not
ensure systems are maintained at vendor-supported levels required to preserve
the accuracy and integrity of its data.
Department of Health – Medicaid Program Claims Processing
Activity April 1, 2022 Through September 30, 2022 (2022-S-12)
During the 6-month period ended September 30, 2022, eMedNY processed over 224
million claims, resulting in payments to providers of nearly $38 billion. OSC’s
audit of Medicaid claims processing activity identified over $16.7 million in
improper Medicaid payments for claims that were not processed in accordance
with Medicaid requirements. The audit also identified 11 providers in the
Medicaid program who were charged with or found guilty of crimes that violated
laws or regulations governing certain health care programs. The Department of
Health removed three of the providers from the Medicaid program and referred
two to the New York State Office of the Attorney General’s Medicaid Fraud
Control Unit; the remaining six providers were under the Office of the Medicaid
Inspector General’s review.
Department of Health – Medicaid Program – Improper
Payments of Medicare Buy-in Premiums for Ineligible Recipients (Follow-Up)
(2022-F-37) Medicaid pays premiums for individuals enrolled
in the Medicare Buy-in Program. A prior audit report, issued in November 2021,
identified $31.7 million in improper premium payments made on behalf of
individuals who were not eligible for the Buy-in Program, an additional $23.6
million in payments made on behalf of individuals with coverage that exceeded
Medicaid’s 2-year premium liability, and $372,716 in premium payments made on
behalf of 282 individuals who were deceased but not disenrolled. The follow-up
found that the Department of Health made some progress in addressing the
problems identified; however, additional actions are needed. Of the initial
report’s five audit recommendations, two were implemented, two were partially
implemented, and one was not yet implemented.
Department of Transportation – Controls Over Vehicle Use
and Transportation-Related Expenses (Follow-Up) (2022-F-38)
The Department of Transportation (DOT) maintains a fleet of 4,086 registered
State-owned and 668 leased vehicles. In addition to its 10 regional repair
shops responsible for vehicle maintenance, DOT also uses a centralized
procurement contract (Contract), negotiated and entered into on behalf of the
State by the Office of General Services, for fleet management and repair
services. The initial audit, issued in July 2021, found that DOT performed
limited to no monitoring of procurements made through the Contractor to ensure
costs were reasonable, despite concerns raised by central office and regional
office personnel. DOT also did little to hold the Contractor accountable for
its responsibility to ensure costs complied with Contract terms. The audit also
identified deficiencies in DOT’s controls over recalls and warranties and its
oversight of fuel and mileage, which increased the likelihood that State funds
were not being used efficiently and effectively and, in the case of open
recalls, posed safety risks. The follow-up found that DOT made progress in
addressing the issues previously identified. Of the initial report’s five
recommendations, four were implemented and one was not implemented.
Port Authority of New York and New Jersey – Selected
Aspects of Accommodations for Passengers With Disabilities (Follow-Up)
(2022-F-24) The Port Authority of New York and New Jersey
(PANYNJ) is required to make its facilities accessible to passengers with
disabilities, pursuant to the Americans with Disabilities Act of 1990 and the
Rehabilitation Act of 1973. The initial report, issued in July 2021, identified
deficiencies and non-compliance with the regulations in areas of the Port
Authority Bus Terminal – the nation’s busiest bus terminal, serving an
estimated 260,000 passenger trips per day. For example, some of the gates were
inaccessible to customers using a mobility device both at the lower and upper
levels, and no signage was evident to direct customers where to seek
assistance. The follow-up found that PANYNJ made progress in addressing the
issues identified. Of the initial seven recommendations, five were implemented
and two were partially implemented.