On
January 24, 2023, following audits
were issued by State Comptroller DiNapoli:
Click
on the text highlighted in color to access
the full text of the audit report.
Department of Health: Medicaid Program – Improper
Payments for Brand Name Drugs (2020-S-62)
The
audit identified $1.1 million in Medicaid overpayments for brand name
prescription drugs where generic drugs were available but not substituted. In
addition, the audit found $1 million in potential cost avoidance associated
with 27,455 Medicaid fee-for-service claims for drugs that appear to be generic
but were paid using brand name pricing methods.
Department of Health: Medicaid Program – Claims
Processing Activity October 1, 2021 Through March 31, 2022 (2021-S-28)
OSC’s
audit of Medicaid claims processing activity identified over $22 million in
improper Medicaid payments for claims that were not processed in accordance
with Medicaid requirements. About $9.9 million of the improper payments had
been recovered by the end of the audit fieldwork. The audit also identified 11
Medicaid providers who were charged with or found guilty of crimes that
violated laws or regulations governing certain health care programs. Upon being
advised of the providers, the Department removed them from the Medicaid
program.
New York City Health and Hospitals Corporation: Controls
Over Equipment (Follow-Up) (2022-F-19)
The
initial audit, issued in January 2019, determined that the New York City Health
and Hospitals Corporation’s (H+H’s) controls over its inventory of equipment
needed improvement, as auditors found equipment tracking problems and
record-keeping issues associated with relinquished, mass-retired, transferred
and repaired assets. The follow-up found that H+H made some progress in
addressing the issues identified. Of the six recommendations from the initial
audit, H+H implemented two and partially implemented one; three recommendations
were not implemented.
Department
of Civil Service: New York State Health Insurance Program – Payments by CVS
Health for Pharmacy Services for Ineligible Members (Follow-Up) (2022-F-29)
The
initial audit, issued in September 2021, found that nearly $30.7 million in
pharmacy service claims were paid on behalf of ineligible members due to data
transfer issues between the Civil Service and CVS systems and retroactive
disenrollment of members. The follow-up found that Civil Service and CVS made
progress addressing the issues identified in the initial audit; namely, Civil
Service and CVS are working to develop a procedure for the recovery of these
and future improper payments. Of the report’s six recommendations, two were
implemented, three were partially implemented and one was no longer applicable.
Department of Civil Service: New York State Health
Insurance Program – Payments by UnitedHealthcare for Medical/Surgical Services
for Ineligible Members (Follow-Up) (2022-F-30)
An
audit issued in September 2021 found that United made a total of $5.7 million
in improper payments for medical/surgical services on behalf of ineligible
members. The follow-up found that Civil Service and United made significant
progress in addressing the issues identified in the initial audit. United
recovered about $500,000 of the $5.7 million in overpaid benefits originally
identified, and Civil Service and United identified another $10.9 million in
claims for ineligible members, of which about $4.9 million has been recovered.
Of the initial report’s three audit recommendations, two were implemented and
one was partially implemented.
State Education Department: Oversight of Career and
Technical Education Programs in New York State Schools (Follow-Up) (2022-F-17)
The
initial audit, issued in December 2020, found that the department did not
provide adequate oversight of CTE programs offered through the secondary school
system to ensure they align with student goals and the needs of the State labor
market – specifically, those occupations that are most in demand, fastest
growing or highest salaried. Auditors also identified several common issues
that are a deterrent to students’ enrollment in CTE and their successful
completion of the program, further contributing to the lack of skilled
employees in certain industries. The follow-up found that the department made
limited progress in addressing the issues identified in the initial audit
report. Of the initial report’s seven audit recommendations, three were
implemented, one was partially implemented and three were not implemented.
Department of Health: Improper Medicaid Payments for
Misclassified Patient Discharges (Follow-Up) (2022-F-21)
The
initial audit report, issued in August 2021, found the department did not have
a process to identify and recover improper Medicaid payments for inpatient
claims with incorrect patient status codes, resulting in $28 million in
improper and questionable Medicaid payments for recipients who were reported as
discharged from a hospital, but then admitted to a different hospital within 24
hours of the reported discharge (which often meets the definition of a
transfer). The follow-up found that the department made some progress in
addressing the problems identified in the initial audit report, but additional
action is still required. Of the initial report’s four audit recommendations,
one was implemented, two were partially implemented and one was not yet
implemented.
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