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Approximately 460,000 New York Medicaid recipients diagnosed with diabetes received diabetes-related services costing more than $1.2 billion in state fiscal year 2013-14, according to a report released by State Comptroller Tom DiNapoli. The report notes that about 1.6 million adult New Yorkers, or 10.3% of the adult population, have been diagnosed with either Type 1 or Type 2 diabetes, which is higher than the 3-year nationwide average of 9.6%.

State Comptroller Tom DiNapoli released 2 audits revealing more than $70 million in questionable Medicaid claims and payments. DiNapoli’s auditors found the state reimbursed providers for excessive services, including 41 dental exams for one patient over three years and identified about a dozen providers that should have been kicked out of the system for wrongdoing. DiNapoli recommended the Department of Health review the overpayments identified and make recoveries, strengthen controls over claims processing to prevent improper payments for excessive services; and review the duplicate Medicaid payments identified and recover, as appropriate. DOH officials generally agreed with the recommendations, but indicated that certain findings were outdated because actions have already been taken to address system shortcomings.

New York collected $149.1 billion in revenue in fiscal year 2014-15, an increase of $11.4 billion, or 8.3% from the prior year, largely because of one-time financial settlements and a boost in federal aid, according to a report by State Comptroller Tom DiNapoli. The state collected more than $71 billion in taxes, Business tax collections of $8.5 billion. The state received $48.6 billion in federal grants, which were used primarily for Medicaid, homeland security, public welfare and education.

State Comptroller Tom DiNapoli announced that audits identified a total of $513 million in improper Medicaid payments and untapped revenue opportunities over a 4-year period. Auditors identified another $361 million in questionable transactions that will require further review and actions to prevent overpayments or recover costs. The state expects to transition the majority of Medicaid spending, services, and enrollees to managed care by 2016, but recent audits by DiNapoli’s office highlight the need for more effective oversight of managed care organizations

The state Department of Health failed to collect nearly $120 million in available rebates over a 33-month period from pharmaceutical manufacturers for the Medicaid program because of ineffective policies and processes, according to an audit by State Comptroller Tom DiNapoli. Auditors determined that the Health department can improve its processes by following 12 recommendations from the report, to collect the unclaimed rebates and improve the collection process.

New York’s Medicaid system overpaid pharmacies by more than $1.1 million over a 5-year period for narcotics and other controlled substance prescriptions that exceeded limits allowed by the law, according to an audit of the Department of Health by State Comptroller Tom DiNapoli. Auditors determined DOH’s eMedNY claims processing system did not properly deny claims from pharmacies for controlled substances that exceeded the supply limits put in place by the Controlled Substances Act and thus prevent improper payment. Medicaid overpaid pharmacies $1.2 million for 13,705 improper claims.

State tax collections of just under $8 billion were $474.2 million higher than expected in December according to the December cash report issued by State Comptroller Tom DiNapoli. The state has also collected $4.2 billion from financial settlements since April, approximately $3.9 billion more than initially anticipated, with another $1.3 billion expected. Total receipts increased 6.5% through December 31st due to settlements and assessment revenues. Tax collections through the first three quarters increased 1.5% Spending from All Funds through December 31st was up by 5.3% from a year earlier, because of Medicaid and spending for education.

The state Department of Health inappropriately paid more than 29,000 pharmacy claims worth nearly $1 million over a 27-month period for thousands of Medicaid recipients whose benefits were already covered by other plans, according to an audit released today by State Comptroller Tom DiNapoli. A second audit released today found another $61,711 in overpayments to providers because of incorrect Medicare coinsurance, copayment or deductible amounts. DiNapoli recommended that the DOH Review and recover improper overpayments; instruct providers to bill Medicare Part C claims in accordance with existing requirements, & assess all claims that auditors did not examine in detail and determine if overpayments were made that warrant recovery.

Governor Cuomo today announced new regulations to include transgender health care services under New York State’s Medicaid program. The proposed regulations provide treatment for hormone therapy and gender reassignment surgery. Under the proposed regulations, hormone therapy and gender reassignment surgery would be covered for persons who have referrals from medical professionals. Surgery would be covered for individuals who are a minimum age of 18 or 21 years old, depending on specific circumstances. The public will have 45 days to comment on the proposed regulation.

Republicans in the state Senate claim that the new federal immigration order could cost New York as much as $2 billion in Medicaid costs. In a letter, Republican Leader Dean Skelos estimated as many as 300,000 immigrants could enroll in Medicaid under the federal policies ordered last month by President Obama. The state has yet to weigh in on what the cost of the new immigration rules will have on New York, which has a large immigrant population. The state Department of Health said it is reviewing the president's order. Gov. Cuomo will release his state budget proposal next month.

Deductibles and co-payments will be flat, with individual premiums rising about 4.5% in New York's health exchange for individuals and families during its 2nd year. State Health Department officials said their exchange has operated smoothly in the 1st year after some initial computer capacity problems. The exchange has enrolled 370,604 people with commercial and nonprofit insurers, 525,283 in Medicaid and 64,875 in the state's Child Health Plus coverage. For the coming year, 16 insurers offer plans for individuals and families, 9 insurers offer coverage for small businesses with 50 or fewer workers. Open enrollment begins Saturday.

1of the nation's biggest credit-rating firms warned New York officials the state's improved rating is at risk as the federal government tries to get back nearly $1.3 billion in Medicaid payments. Moody's Investors Service said the potential Medicaid repayment is a "credit negative" for the state. Officials with Medicare and Medicaid accuse New York of wrongfully paying out money in 2010 for about 1,300 developmentally disabled people in 9 state facilities. Medicaid officials also said they might demand further repayments once reviews of the state's 2011 and 2012 fiscal years are finished. State officials said the state is in good financial shape and windfalls from civil settlements from banks and financial firms will cover any future bill owed to the federal government.

New York should refund $200 million in federal Medicaid overpayments, according to federal health officials. The total is derived from several audits of different parts of the Medicaid program. The State Health Department will appeal the decision. Federal auditors came up with the number as a result of several audits of state-operated facilities, home health care services, day treatment centers for people with mental illness, billing for orthodontic and dental services, and treatment of people with traumatic brain injuries. The federal government pays half the cost of Medicaid health services for the poor in New York.

New York’s health exchange enrolled nearly 1 million people since October, and the largest percentage were aged 26-34. New York nearly met its enrollment goal for 2016 in its first year of the health exchange, signing up 960,762 state residents. 55 percent chose Medicaid, the federal program for the poor and disabled. About 370,000 chose a private insurer; and nearly 65,000 picked Child Health Plus, the state’s insurance program for poor children. The next enrollment period starts Nov. 15

Federal auditors say New York should repay $60.8 million in Medicaid reimbursement, for unallowable costs for room and board for taking care of developmentally disabled people. The U.S. Department of Health and Human Services inspector general said repairs, maintenance, utilities, and property-related costs should have been excluded, in calculating Medicaid payment rates at state-operated residences. The audit recommends the state Health Department refund the $60.8 million federal share of those costs.

A new study shows continued gains in the number of New York children with health insurance, driven mostly by increased converage through public programs.  The Robert Wood Johnson foundation report shows the percentage of childen without insurance dropped from 5.6% in 2008 to 4.3% in 2012.  It shows significant gains among minority children, and children in low income families, as medicaid and children's health insurance programs offset a decline in the number of children covered through private insurance, from 66.6% in 2008 to 6.5% four years later.

New York’s asthma-related Medicaid expenditures rose more than 26% in the last 5 years, as the state’s overall annual asthma bill topped $1.3 billion for medical costs and lost productivity, according to a report released Friday by State Comptroller Tom DiNapoli.  1.7 million people in New York suffer from asthma, according to estimates by the Centers for Disease Control and Prevention. New York’s $55 billion Medicaid program enrolls approximately one in four New York State residents, including 559,000 diagnosed with asthma, and spent $532 million on asthma care in 2013.

The state’s new health exchange reports more than 1 million people have completed applications for insurance, while more than 717,000 have enrolled for specific coverage. The Department of Health said enrollment, for individual and family coverage since October, includes 343,000 New Yorkers, in the 16 commercial and nonprofit insurers in the exchange, and more than 374,000 in government-funded Medicaid. Open enrollments continue through next Monday for 2014 coverage at state-approved rates. Applicants with incomes up to 400% of the federal poverty line are eligible for tax credits to help offset premium payments.  More information is available at health.ny.gov.

Veterans in New York seeking health insurance have been wrongly placed in the state’s Medicaid program, rather than federal programs. State comptroller Tom DiNapoli said the mistakes occurred because of poor coordination between the state Health Department and local social-services departments. The audit found from January 2013 through October 2013, Medicaid paid more than $105 million for services provided to veterans,  many of the veterans were also entitled to benefits through the VA. New York has about 913,000 veterans. To view the report, visit osc.state.ny.us.

New York overcharged the federal government $320 million for residential Medicaid services in 2010. The report, by the Health and Human Services Department inspector general, focuses on rehabilitation services, which help low-income and disabled Medicaid recipients with functional limitations remain socially engaged in their communities. Residences operated by the state, billed the federal government at twice the rate as privately operated residences, offering the same services under Medicaid. State officials said the audit involved practices that began before Governor Cuomo’s administration, and reforms he’s undertaken to streamline the program.

Governor Cuomo announced the largest single year of recoveries of taxpayer dollars in the history of the Office of the Medicaid Inspector General. The administration recovered more than $851 million dollars for 2013 from Medicaid providers who inappropriately billed Medicaid and individuals who received services to which they were not entitled.

Governor Cuomo announced more than $45 million in funding for the Vital Access/Safety Net Provider Program to support projects over the next 3 years by 37 facilities that were selected due to financial condition and critical role in providing services to their elderly population.  The VAP program was established by the Medicaid Redesign Team, the Department of Health will immediately begin working with the facilities to establish goals & track progress, locally, Facilities receiving funding include A.O. Fox Hospital in Oneonta, with over $ 3 million dollars, and Delaware Valley Hospital in Walton, with  $ 221,000.

New York's new online health exchange now reports 197,011 New Yorkers have completed applications to get insured, while 48,162 have enrolled in plans, nearly half in the Medicaid program for low-income residents. The exchange, which opened Oct. 1st as the state's response to the federal Affordable Care Act, includes low-cost plans for individuals and small businesses with coverage starting January 1st. State officials have estimated 1.1 million uninsured will enroll over the next few years.  For more information go to nystateofhealth.ny.gov

New York has joined with other states and the federal government in a $1.6 billion settlement resolving civil and criminal allegations that Johnson & Johnson and its subsidiary, Janssen Pharmaceuticals, promoted the sale and use of Risperdal and Invega for uses not approved by the FDA.  The 2 medications are anti-psychotic medications approved by the FDA to treat schizophrenia and Bipolar Disorder, & not for hyperactivity disorders.  Johnson & Johnson has agreed to pay the states and the federal government more than $1.2 billion in civil damages and penalties to compensate Medicaid, Medicare, and other government programs for prescribing the drugs for issues other their approved usage.

A new study on prison health care costs shows New York 13th among states in spending for inmate care. The study by The Pew Charitable Trust and MacArthur Foundation shows New York spending rose 33% to nearly $5,900 for a prisoner's medical care in 2008. The report says inmates have higher incidence of mental illness and chronic and infectious diseases like AIDS and Hepatitis C than the general population that are costly to treat. New York was among the few states getting Medicaid reimbursements, getting $4.5 million through 2012

Governor Cuomo announced that the  State’s Medicaid Redesign Team Supportive Housing initiative would undertake investments to create new affordable housing units.  The buildings will be located throughout the state, including Broome County. The team has also worked to reform the state’s health care system by reducing costs by $4.6 billion, while adding 154,000 people to the Medicaid rolls.  more information is available at health.ny.gov

With medical expenses among the nation’s highest, New York has begun cutting Medicaid costs by replacing pay-as-you go services with managed care for prescription drugs. The goal is pushing treatment into lower-cost primary care and prevention. The state will also extend that approach to other medical services. Nearly half the $53.5 billion Medicaid budget for 5.3 million low-income New Yorkers goes for fewer than 700,000 chronically ill, elderly patients. The Kaiser Foundation says the state’s annual health care spending averaged $8,341 per person in 2009, fifth highest among states. For more information go to health.ny.gov.

The state Department of Health improperly paid hospitals $7.8 million for lengthy acute care admissions because hospitals billed Medicaid for higher levels of care than was actually delivered to patients, according to an audit by State Comptroller Tom DiNapoli.  94 claims cost the state $10.6 million, as they were improperly billed because the hospitals should have billed for the Alternative care that was actually provided. DiNapoli recommended that the Health Department Recover the $7.8 million in inappropriate payments, notify hospitals of the correct way to bill for Alternative Care; the audit is available @ osc.state.ny.us/audits.

State Comptroller Tom DiNapoli announced that an audit of the state Department of Health revealed an overpayment of $66,000 in Medicaid claims to Oneonta Dentist Dr. Prosper Bonsi.  Bonsi is accused of submitting over 2300 claims for “Behavior Management” & after hours visits, DiNapoli suggested that the state retrieve $66,000 from Dr. Bonsi, and actively monitor Bonsi’s claims in the future.

PM NEWS 7-9-13

The annual Gus Macker 3 on 3 basketball tournament will be held this weekend in Norwich. The event features over 400 teams from ages 7 to 50 plus and brings thousands of spectators to the area. Organizer Tom Revoir said they are still in need of Gus Buster volunteers....
(Revoir)
Revoir added that Court Monitors for the adult courts are especially needed. If you are particpating in the Macker, there have been some minor bracket changes and you are asked to go to Macker dot com to see if your team is affected.

New York State’s Medicaid program overpaid providers 11.4 million dollars according to state Comptroller Thomas Dinapoli. Dinapoli said it is largely due to overstated amounts by providers and incorrect rate changes. Dinapoli blames weak controls and poor supervision of the program. Only 3.8 million of medicaid overpayments have been recovered.

An Oneonta man, wanted on a parole violation, was arrested on felony burglary and other charges. The burglary report came from a Spruce Street resident and police are investigating recent burglary attempts on Elm Street to see if the incidents are connected. 26 year old Tim Button was arrested Sunday. Button was charged with second-degree burglary. Button also was charged with fifth-degree criminal possession of stolen property and pety larceny, and was sent to Otsego County jail on $10,000 bail.

State Troopers arrested 19 year old Mike Foley of Port Crane, for Unlawful Possession of Marihuana and Unlawful Possession of Alcohol by a person under the age of 21, following a traffic stop on State Route 7 in the Town of Colesville. Foley was issued an appearance ticket for town of Colesville court at a later date.

State police arrested 75 year old Peter Pizzillo of Margaretville for 3rd degree assault following a complaint in the village of Margaretville. Pizzillo was arraigned in town of Roxbury court and sent to the Delaware County Jail on $250.00 bail.

Hartwick College in Oneonta is featured in the 2014 edition of The Fiske Guide to Colleges as one of the country’s best and most interesting colleges. The guide includes about 300 colleges and universities from among more than 7,000 higher education institutions across the country. The schools were chosen based on areas such as academics, social life, financial aid, campus setting and extracurricular activities.

An underage drinker initiative detail from the State Police checked retail convenient stores in Otsego County in Worcester, Milford, Hartwick, Cooperstown and Richfield Springs. Arrests were made at the Pit Stop in the town of Hartwick and at Stewart's Shop in Richfield Springs. Police charged 31 year old Ajay Ghiaar of Cooperstown and 21 year old Victoria Oldick of Fort Plain for unlawfully selling alcohol to a person under the age of 21.

The Delaware County Office for the Aging has announced that Farmers Market coupons for senior citizens 60 years and older are now available. Eligible Delaware County seniors can receive twenty dollars worth of free New York State grown produce. Produce coupons can be picked up at the Delaware County Office for the Aging at 6 Court Street in Delhi weekdays from 8am to 4pm. For information, call 746-6333 or go to …ofa@co.delaware.ny.us