Selected reports and information published by New York State's Comptroller Thomas P. DiNapoli
Issued during the week ending March 1, 2013 [Click on text highlighted in bold to access the full report]
The state Department of Health [DOH] made $26 million in Medicaid overpayments and other questionable payments because of flaws in its eMedNY claims processing computer system according to an audit released on March 1, 2013 by State Comptroller Thomas P. DiNapoli.
DOH officials generally agreed with the audit’s findings and have begun to implement the recommendations. For a copy of the report, including DOH’s response, click on:
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:
· Correct the eMedNY computer controls that caused the Medicaid overpayments identified during the audit;
· Recover the Medicaid overpayments totaling $10 million caused byeMedNY computer programsthat incorrectly processed Medicare crossover claims; and
An initial audit found that districts are intervening in a timely and appropriate manner to protect the children who are at risk in the most serious types of child abuse cases. However, the actions taken are not summarized in a format that would enable OCFS to readily determine that necessary interventions have actually occurred. In a follow-up report, auditors determined OCFS officials have not made progress in correcting the problems identified in the initial report.
In November 2007, the Private Housing Law was amended to require housing companies to provide disabled veterans with a preference in the admission to Mitchell-Lama housing developments. An initial audit found disabled veterans did not receive the intended housing preference. The individual Mitchell-Lama housing companies failed to follow the Division’s guidance concerning the law, and the division failed to monitor the housing companies adequately. In a follow-up report, auditors found DHCR officials have made significant progress in correcting the problems identified in the initial report.
As part of a statewide initiative to determine whether the use of travel money by selected government employees was appropriate, Auditors examined travel expenses for the highest-cost travelers in the State. In an audit of $1,293,461 of the college’s travel payments, auditors found two Alfred employees had travel costs totaling $224,683. Auditors also examined other travel expenses, including $1,037,509 paid to a provider of campus services such as transportation, vending, and concessions, and airfare expenses incurred by one employee that totaled $31,269. Auditors found that the travel expenses for the three employees and the service provider were documented and adhered to state travel rules and regulations.
As part of a Statewide initiative to determine whether the use of travel money by selected government employees was appropriate, auditors looked at travel expenses for the highest-cost travelers in the state. Auditors found five SUNY Cortland employees had travel costs totaling $696,909. The travel expenses for the employees selected for audit were documented and adhered to state travel rules and regulations.
As part of a statewide initiative to determine whether the use of travel money by selected government employees was appropriate, auditors looked at travel expenses for the highest-cost travelers in the state.
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.
As part of a statewide initiative to determine whether the use of travel money by selected government employees was appropriate, auditors looked at travel expenses for the highest-cost travelers in the state.
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.