Purpose

The objectives of our examination were to determine if payment requests and payments DOL approved were appropriate and in accordance with applicable Federal and State laws and regulations and DOL policies and procedures, and if DOL recouped overpayments based on our findings.

Background

To accomplish our objectives, we used data analytics to select 69,646 transactions for audit, including: (i) high risk payment requests DOL approved in 2015; and (ii) prior year payments related to those 2015 payment requests. For example, we analyzed the daily UI payment file to identify potential inappropriate payment requests and to verify claimant eligibility. Other data analytics performed included matching: (i) the Department of Taxation and Finance wage file to the DOL payment file to identify payments made to claimants that may have been employed while collecting benefits; (ii) monthly and quarterly payment files to identify duplicate payments; and (iii) out of country indicators in the claimants’ log file to the DOL payment file to identify claimants collecting benefits while out of the country.

Key Findings

• We identified 11,306 overpayments totaling more than $3.6 million. This includes $93,760 in current payment requests stopped, $280,276 in future payments that would have been made over the life of the claim had DOL not taken corrective action based on our findings, and $3,311,848 in erroneous payments made. Based on the errors identified, DOL assessed $471,458 in monetary penalties to 344 claimants.
• We identified 588 underpayments totaling $105,744. This includes $23,662 in current payment requests stopped and $82,082 in future payments claimants would not have received over the life of the claim had DOL not taken corrective action based on our findings.
• Our Office and DOL worked cooperatively to identify other potential recoveries totaling $284,315 from 205 New York State employees hired during calendar year 2015 who owe DOL for UI overpayments received in prior years.
• DOL has recovered $253,968 in forfeited UI benefits from claimants who made false statements or representations to obtain benefits they were not eligible to receive, and $488,138 from New York State employees who owed DOL for UI overpayments made in prior years.

Key Recommendations

• Enhance controls to identify claimants falsely certifying eligibility to receive UI benefits. Prosecute these individuals to the fullest extent of the law when it is economically beneficial to do so.
• Continue to develop a modernized UI system and provide our Office with a report on the progress made to date and target dates for future milestones.
• Address the system limitations in the UI payment system identified in this report.
• Ensure staff follows established policies and procedures to process claims appropriately.
• Consider periodically reviewing individual claims in their entirety.
• Recoup overpayments and monetary assessments from claimants, as appropriate.