Institutional Federal Compliance Report 2021

STATE OF NEW YORK

Schedule of Findings and Questioned Costs

March 31, 2019

the period 8 weekly cycles selected, the providers were determined during the fiscal year to be ineligible providers and were terminated within the State’s MMIS and assigned a historical effective date reflective of the date the provider was no longer eligible. As there is a timing lag between the date the termination was processed within the MMIS and the effective date of the provider eligibility, subsequent claims were paid to these providers and management did not have a process in place to retroactively recoup the amounts paid. The 6 identified ineligible providers claimed and were paid $22,622 for Medicaid during the 8 selected cycles, which were not allowable claims as they were subsequent to the provider becoming ineligible but prior to management processing the termination within the system. Cause The Department does not have a process in place to review and recoup claims paid under the Federal Medicaid program when a termination is processed within the Department’s MMIS system that has a prior effective date. Possible Asserted Effect Failure to appropriately identify providers’ payments made subsequent to the termination of provider agreements resulted in ineligible providers receiving federal funds. Questioned Costs $22,622 (total payments to the six terminated or inactive providers) Statistical Sampling The sample was not intended to be, and was not, a statistically valid sample. Repeat Finding A similar finding was included in the 2018 Single Audit Report as finding 2018-031 on pages 90–91. Recommendation We recommend that the Department revise its process and internal controls to ensure that the claims paid to providers that are inactive or terminated within the MMIS system with an effective date prior to the date of termination are reviewed to ensure any payment made subsequent to their effective ineligibility date are recouped by the Department. Views of Responsible Officials Recommendation accepted. Corrective action in progress. Reference the corrective action plan for further details.

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