New York State Comptroller Thomas P. DiNapoli announced today the following audits have been issued.
Department of Health – Improper Medicaid Payments for Outpatient Services Billed as Inpatient Claims (Follow-Up) (2024-F-26)
A recipient’s status in a hospital—inpatient versus outpatient—affects Medicaid’s reimbursement for services provided, with outpatient services generally costing less. A prior audit, issued in August 2023, identified 34,264 fee-for-service inpatient claims, totaling $360.6 million, where hospitals reported Medicaid recipients were discharged within 24 hours of admission, indicating a high risk that a portion of these claims were improper if the services provided should have been billed as outpatient. From a judgmental sample of 190 claims, totaling $4,261,428, from six hospitals, auditors found 91 claims (48%), totaling $1,577,821, were billed improperly. Department of Health and Office of the Medicaid Inspector General officials made little progress in addressing the problems identified in the initial audit report, partially implementing three of five recommendations and not implementing two.
New York State Health Insurance Program: CVS Caremark – Accuracy of Empire Plan Commercial Rebate Revenue Remitted to the Department of Civil Service (2023-S-42)
The New York State Health Insurance Program (NYSHIP), administered by the Department of Civil Service (Civil Service), provides health insurance coverage to about 1.2 million active and retired State, participating local government, and school district employees, and their dependents. The Empire Plan is the primary health benefits plan for NYSHIP, covering over 1 million members. Since 2014, the Department of Civil Service has contracted with CVS Caremark to administer the prescription drug program. In accordance with the contracts, CVS Caremark was required to negotiate agreements with drug manufacturers for rebates, discounts, and other consideration (collectively referred to as “rebates”) and remit the rebate revenue to Civil Service. Based on judgmental samples of 10 manufacturers and 25 drugs, auditors identified $1,160,286 in rebates that is due to Civil Service from CVS Caremark.
State University of New York – Oversight of the Educational Opportunity Program (2024-S-2)
The State University of New York (SUNY) operates the Educational Opportunity Program (EOP), which provides access, support, and financial aid for disadvantaged students who show the potential to succeed despite poor academic preparation and limited financial resources. EOP includes a pre-freshman summer orientation program for incoming students and provides support and enrichment programs, including career advising, tutoring, and personal counseling, throughout students’ enrollment. During the Fall 2023 semester, EOP operated on 28 State-operated SUNY campuses and served 5,969 EOP participants. While SUNY is monitoring EOP, and campuses were generally using the funds for allowed purposes, auditors identified some unallowable or insufficiently supported transactions and lack of support that some counseling services to students were actually provided.
Department of Motor Vehicles – Assessable Expenses of Administering the Motor Vehicle Financial Security Act and the Motor Vehicle Safety Responsibility Act for the State Fiscal Year Ended March 31, 2024 (2024-M-2)
The Motor Vehicle Financial Security Act and the Motor Vehicle Safety Responsibility Act help ensure that the operators of motor vehicles driven in New York State possess adequate insurance coverage, or are financially secure, to compensate those persons they might injure or whose property they might damage as a result of an accident. The Department of Motor Vehicles is responsible for tracking the expenses of administering the acts and assessing these expenses on insurance carriers that issue policies or contracts of automotive bodily injury insurance. Auditors found that the expenses for administering the acts for the State Fiscal Year ended March 31, 2024 totaled $33.2 million.
City University of New York – Open Educational Resources (2023-N-4)
Open Educational Resources (OER) are any teaching, learning, and research materials that are in the public domain or are under copyright but have been released under an open license and are available to students at no or low cost. During the six City University of New York (CUNY) fiscal years ended June 30, 2023, CUNY received a total of $24 million in New York State funds to expand OER initiatives as part of an effort to create OER to reduce textbook costs. To maximize the effectiveness and transparency of CUNY’s OER program, improvements are needed in oversight and accountability. For example, auditors found CUNY did not track $17,674,400 of the $24 million in OER funds received from the State for the 2018–2023 CUNY fiscal years, providing no assurance the funds were used for course conversion and OER activities. CUNY also spent $238,094 in other than personal services expenses that were unsupported, not OER related, or questionable, and auditors found errors and omissions in CUNY’s OER reporting that could be misleading to students when registering for courses.