New York State Comptroller Thomas P. DiNapoli announced today the following audits have been issued.
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.
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 Of the report’s six recommendations, two were implemented, three were partially implemented and one was no longer applicable.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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