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NYS Comptroller

THOMAS P. DiNAPOLI

Taxpayers' Guide to State and Local Audits

Department of Health
Improper Fee-for-Service Payments for Pharmacy Services Covered by Managed Care
(Follow-Up)


Issued: September 23, 2016
Link to full audit report 2016-F-5
Link to 30-day response

Purpose
To determine the extent of implementation of the three recommendations included in our initial audit report, Improper Fee-for-Service Payments for Pharmacy Services Covered by Managed Care (Report 2014-S-5).

Background
Our initial audit report, which was issued on January 5, 2015, determined that, for the 27-month period, October 1, 2011 through December 31, 2013, Medicaid inappropriately paid 29,289 fee-for-services pharmacy claims totaling $978,251 on behalf of 18,010 Medicaid recipients whose pharmacy benefits were covered by managed care. We recommended the Department review the improper payments we identified and recover overpayments as appropriate. We also recommended the Department take corrective action to help ensure managed care enrollment information is entered and update timely and to determine why certain fee-for-service claims were inappropriately paid and take any necessary corrective actions.

Key Finding

  • Department officials have made some progress in addressing the problems we identified in the initial audit report.  However, further actions are still needed.  Of the initial reports three recommendations, two were implemented and one was not implemented.

Key Recommendation

  • Officials are given 30 days after the issuance of the follow-up report to provide information on any actions that are planned to address the unresolved issues discussed in this report.

Other Related Audits/Reports of Interest

DOH Medicaid Program: Improper Fee-for-Service Payments for Pharmacy Services Covered by Managed Care (2014-S-5)


State Government Accountability Contact Information:
Audit Director: Andrea Inman
Phone: (518) 474-3271; Email: StateGovernmentAccountability@osc.state.ny.us
Address: Office of the State Comptroller; Division of State Government Accountability; 110 State Street, 11th Floor; Albany, NY 12236