New York State Comptroller Thomas P. DiNapoli announced the following
audits and reports were issued on July 31 2023.
Click on the text highlighted in color to access the entire audit report.
State Education Department (Preschool Special Education
Audit Initiative) – Step Up Therapy Services, PLLC – Compliance With the
Reimbursable Cost Manual (2021-S-31)
Step Up, a New
York City-based not-for-profit organization, is approved by the State Education
Department to provide preschool special education itinerant teacher services to
children with disabilities who are between the ages of three and five
years. For the three fiscal years ended June
30, 2015, Step Up reported approximately $7.4 million in reimbursable
costs for the SED preschool cost-based program. Auditors identified $810,382 in
reported costs that did not comply with requirements.
Department of Health – Improper
Supplemental Maternity Capitation Payments to Managed Care Organizations
(Follow-Up) (2023-F-3)
Many of the
State’s Medicaid recipients receive their services through managed care,
whereby the Department of Health (DOH) pays managed care organizations (MCOs) a
monthly premium for each enrolled recipient and, in turn, the MCOs pay for
services their members require. In addition to the monthly premiums, MCOs can
receive a one-time Supplemental Maternity Capitation Payment (SMCP) for the
prenatal and postpartum physician care and hospital or birthing center delivery
costs associated with the maternity care of a recipient. MCOs are not eligible
to receive SMCPs for maternity cases that end in termination or a miscarriage,
as these are considered reimbursed to the MCO through the monthly premium for
the recipient, and must submit encounter claim data as evidence of the delivery
and any other inpatient and outpatient maternity services provided.
A prior audit
report, issued in November 2021, found about $55 million in improper and
questionable SMCPs to MCOs. Auditors also determined DOH’s eMedNY claims
processing system did not have access to maternity encounter data to verify
that SMCP claims were eligible for reimbursement. Instead, DOH relied on audits
by the Office of the Medicaid Inspector General (OMIG) to identify and recoup
inappropriate SMCPs. However, auditors found OMIG was not performing these audits
in a timely manner and the audits did not capture all improper SMCPs.
The follow-up
found that DOH made some progress in addressing the problems identified in the
initial audit report, but additional actions are still required. For example, a
significant portion of the questionable claims identified have not been
reviewed, and DOH has not followed up with the 10 MCOs identified in the
initial audit to ensure issues with their claims processing systems were
resolved. Of the initial report’s six audit recommendations, three were
partially implemented, and three were not implemented.
Metropolitan Transportation Authority – Fare Evasion
(Follow-Up) (2022-F-23)
For 2018, the
Metropolitan Transportation Authority (MTA) reported a total of $225 million in
revenue loss due to fare evasion at New York City Transit (Transit) and MTA
Bus. Among other actions, the MTA launched the Fare Enforcement and Worker
Safety Program (Program) to deter fare evasion. A prior report, issued in April
2021, found that the MTA did not provide assurance that the Program was
effective in achieving its goal of reducing annual fare evasion losses below
2017 levels ($150 million). Instead, Transit estimated that it lost more than
$300 million to fare evasion in 2019. Since the initial report was issued, the
subway and bus fare evasion rates have increased. The first quarter of 2023
(January–March) saw an increase of 11.1% (± 0.9%) for subways and an estimated
increase of 37.6% for buses. After the audit’s release, the MTA created a
Blue-Ribbon Panel to reduce fare evasion across the MTA system. On May 17, 2023, the panel released its report, which
incorporates several of the recommendations of the initial audit report. The
follow-up found that the MTA made progress in addressing the issues identified
in the initial audit. Of the initial report’s 19 audit recommendations, 13 were
implemented, four were partially implemented, one was not implemented, and one
is no longer applicable.
State Board of Elections – Use of
Federal Funding for Election Technology and Security (Follow-Up) (2022-F-35)
The Help America
Vote Act of 2002 (HAVA) was enacted to help reform the nation’s voting process.
In June 2018, the Board of Elections (BOE) received $19.5 million in HAVA
funding to improve and enhance election administration, technology, and
security, including $3.3 million that it designated to reimburse County Boards for their remediation
activities. A prior audit, issued in September 2021, found the BOE utilized
HAVA funding appropriately. However, of the 57 County Boards, only seven had
submitted claims for reimbursement, showing that they had moved forward with
the needed security measures. The follow-up found that BOE has made significant
progress addressing the issues identified, having implemented the one
recommendation from the initial report to ensure County Boards take the necessary
action to improve security.
New York City Department of Buildings –
Oversight of Sidewalk Sheds (Follow-Up) (2022-F-36)
The New York
City Department of Buildings (DOB) is responsible for regulating the safe and
lawful use of more than 1 million buildings and construction sites in the city,
including sidewalk sheds (sheds) – temporary structures installed and
maintained to protect people and property on city sidewalks during the
construction, demolition, and maintenance of buildings. A prior audit report,
issued in July 2021, found that DOB was not adequately overseeing and
monitoring the timely installation and removal of sheds or ensuring that sheds
were properly maintained. For example, the audit found unsafe façades with no
installed sheds, sheds with hazardous conditions, and sheds without valid
operating permits. The follow-up found that DOB has made limited progress in
addressing the problems identified in the initial audit. Of the initial
report’s 15 recommendations, four were implemented, two were partially
implemented, and nine were not implemented.
Division of Homeland Security and Emergency Services –
Cyber Incident Response Team (Follow-Up) (2023-F-8)
In 2017, the
Cyber Incident Response Team (CIRT) was created within the Division of
Homeland Security and Emergency Services (DHSES) to provide cybersecurity
support to more than 2,800 non-Executive agencies, local governments, and
public authorities in New York. A prior audit report,
issued in November 2021, found that CIRT developed lines of service to guide
its work – cyber incident response services, technical cyber services, and
information sharing and outreach – but did not establish specific and
measurable objectives or quantifiable goals that could be measured to evaluate
its accomplishments. The follow-up found that DHSES made progress in addressing
the issues identified in the initial audit report; however, additional actions
are needed. Of the initial report’s two audit recommendations, one was
implemented and one was partially implemented.
New York State Health Insurance Program
– UnitedHealthcare Insurance Company of New York: Improper Payments for
Acupuncture and Acupuncture-Related Services (Follow-Up) (2023-F-14)
The Department
of Civil Service (Civil Service) contracts with UnitedHealthcare Insurance Company
of New York (United) to administer the Empire Plan’s
medical/surgical benefits, including acupuncture and acupuncture-related
services such as heat and massage therapy. A prior audit report, issued in
October 2021, identified $7.3 million in actual and potential overpayments for
services that were not supported by provider documentation and for duplicate
payments. The follow-up found that United made minimal progress in addressing
the issues identified in the initial audit. At the time of the follow-up,
United had recovered only $14,281. Further, United was not able to provide
evidence of additional control enhancements designed to prevent duplicate
payments. Of the initial report’s four recommendations, one was implemented,
two were partially implemented, and one was not implemented.