Institutional Federal Compliance Report 2021

STATE OF NEW YORK

Schedule of Findings and Questioned Costs

March 31, 2019

Federal Agency:

United States Department of Health and Human Services

Federal Program:

Medicaid Assistance Program Cluster (93.775, 93.777, and 93.778)

Federal Award Numbers:

1805NY5MAP and 1805NYINCT

Federal Award Years:

2016, 2017, 2018, and 2019

State Agency:

Department of Health

Reference:

2019-023

Criteria Title 42 U.S. Code of Federal Regulations Part 431 (42 CFR 431), State Organization and General Administration , section 431.107(b), Agreements , states a State plan must provide for an agreement between the Medicaid agency and each provider or organization furnishing services under the plan in which the provider or organization agrees to:

(1) Keep any records necessary to disclose the extent of services the provider furnishes to beneficiaries;

(2) On request, furnish to the Medicaid agency, the Secretary, or the State Medicaid fraud control unit (if such a unit has been approved by the Secretary under§ 455.300 of this chapter), any information maintained under paragraph (b)(1) of this section and any information regarding payments claimed by the provider for furnishing services under the plan;

(3) Comply with the disclosure requirements specified in part 455, subpart B of this chapter; and

(4) Comply with the advance directives requirements for hospitals, nursing facilities, providers of home health care and personal care services, hospices, and HMOs specified in part 489, subpart I, and § 417.436(d) of this chapter.

(5) Furnish to the State agency its National Provider Identifier (NPI) (if eligible for an NPI); and

(6) Include its NPI on all claims submitted under the Medicaid program.

Additionally, Title 45 U.S. Code of Federal Regulations Part 75 (45 CFR 75), Uniform Administrative Requirements, Cost Principles, and Audit Requirements for HHS Awards , section 75.303(a) states the nonfederal entity must establish and maintain effective internal control over the Federal award that provides reasonable assurance that the nonfederal entity is managing the Federal award in compliance with Federal statutes, regulations, and the terms and conditions of the Federal award. Condition The Department of Health (the Department) did not have a process in place to recoup payments made to a provider when the provider was identified to no longer be an eligible provider at a date prior to the effective termination date within the State’s Medicaid Management Information System (MMIS).

For 8 out of 52 weekly cycles, Medicaid beneficiary claims paid through State’s Medicaid Management Information System (MMIS) were made to a total of 71,056 providers. For 6 of the 71,056 providers paid during

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