The Office of the New York State Comptroller (OSC) has issued three audit reports on activities of the New York State Department of Health (NYSDOH).  OSC found that NYSDOH was making millions of dollars in improper Medicaid payments through improper dual enrollment in Medicaid and the Essential Health Plan and through improper enrollment in the Managed Long-Term Care program.  OSC also found that NYSDOH was not always conducting radiation equipment facility inspections in a timely manner.  You can access and read the OSC audit reports below.

Department of Health – Medicaid Program – Improper Overlapping Medicaid and Essential Plan Enrollments (Follow-Up) (2023-F-40)

The Department of Health (DOH) administers the State’s Medicaid program and the Essential Plan, which provides health insurance to lower-income people who, generally, don’t qualify for Medicaid.  A prior audit, issued in October 2022, identified $36.5 million in Medicaid payments and $16.2 million in Essential Plan payments on behalf of 4,422 recipients with the same Social Security number; and additional payments totaling $3.8 million by Medicaid and $2.2 million by the Essential Plan on behalf of 603 recipients who had other matching demographic data when Social Security numbers were not available, such as name, date of birth, and gender.  Furthermore, DOH did not have a process to detect and correct these improper duplicative enrollments, nor did it have a process to recover improper payments caused by the overlapping enrollments.  DOH officials made some progress in addressing the problems identified in the initial audit report; however, additional actions are needed.  Of the initial report’s three audit recommendations, two were partially implemented and one was not implemented.

Department of Health – Oversight of Registration, Licensing, and Inspection of Radioactive Materials Facilities and Radiation Equipment Facilities (Follow-Up) (2023-F-28)

The Department of Health (DOH) is responsible for the supervision and regulation of radiation and radioactive materials in New York State, outside of New York City.  DOH duties include licensing and inspecting approximately 1,100 radioactive materials facilities (RAM facilities), as well as registering and inspecting approximately 9,900 radiation equipment facilities that use diagnostic, mammography, and stereotactic equipment.  A prior audit, issued in September 2021, found that DOH completed 94% of RAM facility inspections on time, but 44% of those inspections were completed beyond the established 1- to 5-year inspection time frames by relying on a buffer that was intended to allow for more flexibility and logical extensions to the inspection intervals, such as for staff time and travel.  DOH made some progress in addressing the problems identified in the initial audit report; however, more work needs to be done.  Of the initial report’s four recommendations, one was implemented, one was partially implemented, and two were not implemented.

Department of Health – Medicaid Program – Oversight of Managed Long-Term Care Member Eligibility (Follow-Up) (2023-F-29)

Many of the State’s Medicaid recipients are enrolled in managed long-term care (MLTC) plans, which provide long-term care services for people who are chronically ill or disabled.  To be eligible for MLTC enrollment, individuals must be assessed as needing community-based long-term care (CBLTC) for more than 120 days.  A prior audit, issued in August 2022, identified $701 million in improper Medicaid MLTC premiums on behalf of 52,397 recipients who were no longer eligible for MLTC and Medicaid paid $2.8 billion in MLTC premium payments on behalf of 51,947 recipients who received a limited number of CBLTC services, and DOH did not have a process to monitor that enrollees were properly assessed or had access to the care they needed.  The follow-up found that less than 5% of the $701 million in improper MLTC payments had been recovered and DOH still needed to develop a process to identify and monitor ineligible enrollees in between assessments.  Of the initial report’s four audit recommendations, one was implemented, two were partially implemented, and one was not implemented.