WCDO Radio News

State Comptroller Tom DiNapoli has completed a study of the $277 billion Enacted Budget for the current State Fiscal Year, which has an increase of 7% from the previous State Budget. DiNapoli's report stated the largest increases in spending have been in Medicaid and School Aid, other potential issues are the the retrenchment of federal support; persistent inflation and increasing local government fiscal needs, also the state took action to preserve healthcare coverage for over a million New Yorkers, but that still resulted in 450,000 New Yorkers losing eligibility. The state has significantly increased its reserve levels at approximately $15 billion.

35 Year old Ciera Washington of the Bronx pleaded guilty in US District Court to conspiracy to commit health care fraud and aggravated identity theft. Washington admitted that from April 2023 through October 2024, she worked with 2 others to steal the personal information of Medicaid beneficiaries and use that information to fraudulently obtain prescription medications from pharmacies throughout New York State & the Northeastern States, which caused a loss of nearly $4 million to the Medicaid program and tens of thousands of dollars to pharmacies. Washington agreed to forfeit over $400,000 in proceeds from her crimes and to consent to an order of restitution for the losses they caused. Washington faces up to 10 years’ imprisonment on the fraud count and a mandatory term of 2 years on the aggravated identity theft count, which must run consecutively, when sentenced in October in Federal Court, She also faces a term of supervised release of up to 3 years.

New York Attorney General Letitia James joined a coalition of 36 other attorneys general and the U.S. Department of Justice in securing $36.5 million from CVS Pharmacy, for fraudulently over-billing Medicaid for insulin prescriptions. From 2010 to 2020, CVS knowingly dispensed more insulin to customers than they needed while maintaining that they were reporting the correct amount of insulin in their prescriptions. The fraudulent claims allowed the company to rake in millions in extra reimbursements from Medicaid for insulin distribution. CVS will pay more than $25 million to state Medicaid programs across the country, including $2.25 million to New York.

Attorney General Letitia James won a court order preventing the federal government from enforcing a provision in the so-called "One Big Beautiful Bill Act" that would strip Planned Parenthood of its Medicaid funds, jeopardizing health care for millions of low-income patients across the country. Attorney General James joined a coalition of 21 other attorneys general and the governor of Pennsylvania in suing the Department of Health and Human Services to block the provision, The United States District Court for the District of Massachusetts issued a ruling granting the coalition's motion for a preliminary injunction, ordering HHS to continue paying Medicaid funds to all states and clinics in the coalition.

P.M. NEWS WEDNESDAY 10-1-25

Today is Day 1 of the Federal Government shutdown, which could have dire circumstances for the typical New York Family, according to US Senator Kirsten Gillibrand:

(Gillibrand 10-1-25)

Gillibrand also said that the shutdown jeopardizes the Affordable Care Act, where subsidies are set to expire at the end of this year if no action is taken by Congress, it has been the U.S. health care system for 15 years, providing access to more affordable, health care through provisions like Marketplaces for individual insurance plans, expansion of Medicaid, and patient protections such as coverage of pre-existing conditions.

The state’s Financial Plan shows a growing budget deficit with 3-year budget gap of $34.3 billion, as predicted similar to the Financial Crisis of 2009, according to State Comptroller Tom DiNapoli. Higher spending growth in school aid and Medicaid has driven overall state spending growth, and the State Budget was released prior to the federal budget, which called for deep cuts to federal funding and changes to eligibility for safety net programs. The full report can be found at osc.ny.gov.

State Comptroller Tom DiNapoli released his conclusion on this year's State Budget, which came to a total $254 billion, a 5.2% increase in spending. DiNapoli questioned the increase in spending when federal actions on funding to states could decrease revenues, and that could lead to a shortfall before the end of the fiscal year. The biggest items in the budget were 37.4 Billion dollars for schools & 109.6 billion for Medicaid in the Department of Health’s budget. All Funds revenues are projected to total $248.9 billion, nearly the same as last year, tax collections are projected to decrease by less than 1% to $117 billion.

U.S. Senator Kirsten Gillibrand is opposing a Republican proposal that would cause over a million New Yorkers to lose their Medicaid coverage:

(Gillibrand 5-14-25)

The Congressional Budget Office estimates the bill would cut federal spending on healthcare by more than $700 billion over a decade, the largest Medicaid cut in history, The proposed changes include adding new work requirements, new cost-sharing fees for Medicaid enrollees and much stricter and more frequent eligibility checks.

New York State Department of Health’s computer system improperly paid $16.2 million in Medicaid claims during a 6-month period that started in October 2023, according to an audit released today by State Comptroller Tom DiNapoli. Overall, the audit found 370 million claims were processed between October 2023 through March 2024, totaling nearly $49.6 billion.

An audit released by State Comptroller Tom DiNapoli found Medicaid managed care organizations made as much as $1.5 billion in improper and questionable payments to providers who did not appear to be enrolled in Medicaid. 5 Managed care Organization were paid $916 million in claims for services by in-network providers whose IDs did not match with a Medicaid enrolled provider on the date of service, $832.5 million in claims were for services by providers whose Medicaid application was denied or had been withdrawn because they failed to meet Medicaid standards or the application was missing information. The full report can be found at osc.ny.gov.

Delaware County Sheriff's Office arrested 28 year old Kenneth Dillman of Stamford for Aggravated Unlicensed Operator of a Motor Vehicle and Operation of a Motor Vehicle with an Ignition Interlock device following a traffic stop in the Town of Harpersfield. Deputies observed Dillmann operating a motor vehicle, they knew that Dillmann had 22 suspensions on his revoked license, A traffic stop was conducted, Dillmann was charged & was issued traffic tickets and Appearance Tickets for Town of Harpersfield Court at a later date.

A.M. NEWS WEDNESDAY 3-13-24

State Comptroller’s Office announced that 2 Otsego County area businessmen have been indicted for a $1 million Medicaid transportation fraud scheme. 46-year-old Philip Mtui and 47-year-old Mbaga Kaiza were partners in Phinaliz Communications, they allegedly sought and received payments for rides that did not actually happen and billed multiple times for rides that did occur. This resulted in $1 million being stolen from Medicaid, they were charged with 1st Degree Grand Larceny & they face court action on May 6.

Congressman Marc Molinaro announced details for a Telephone Town Hall he will host on Wednesday, at 11:00am to help Upstate New York seniors navigate the Medicare Open Enrollment Period. On the call, Molinaro will be joined by experts from the Centers for Medicare and Medicaid Services and Elevance, a Medicare provider. To sign up to receive a call for Rep. Molinaro's Telephone Town Hall, fill out the form at molinaro.house.gov/forms by 5:00 pm today, Seniors can also listen in by calling (833) 560 2070.

State Comptroller Tom DiNapoli, the Otsego County Sheriff's Office & The Oneonta Police Department announced the arrests of 3 people of Phinaliz Communications LLC, who are accused of operating a long-running scheme to steal over $1 million from the Medicaid program. The 3 defendants were identified as 46 year old Philip Mtui of Mechanicsville, who owns the company, operations manager Mbaga Kaiza, and Dispatcher & Driver Tony Taylor, who were arrested last Thursday. Over a 4-year period, Mtui and Kaiza defrauded the Medicaid program by claiming payment for rides that never occurred, and double, triple, or quadruple billing for rides that did occur. Mtui and Kaiza were arraigned in Oneonta City Court for 1st degree Grand Larceny, both were held on $250,000 bail. Taylor was arrested on 1 count of conspiracy, he will be arraigned on September 19th, more arrests are expected.

The State Comptroller's Office audited the state Department of Health, reporting that they need to make sure that they get the drug rebates that it is entitled to under federal regulations. State Comptroller Tom DiNapoli said that the largest portion of money left on the table was $109.4 million in rebates, following an error on 490,875 claims that incorrectly showed that no Medicaid payment had been made, making them ineligible for rebates, another mistake with Magellan resulted in missing out on $9.6 million in rebates.

Senate Majority Leader Chuck Schumer announced Wednesday the Center for Medicare and Medicaid Services has reversed its eligibility criteria for Critical Access Hospital status. The program allows rural healthcare providers to receive federal reimbursements to help ensure they are able to service patients. The rule reversal is expected to go into effect January 1st.

The State Department of Health made $965 million in payments to providers, including facilities, for services ordered, prescribed, referred, and attended by practitioners who were not enrolled in the health care program, including those who had been barred due to misconduct, according to an audit released today by State Comptroller Tom DiNapoli. DiNapoli recommended that the Department of Health Review the $965 million in payments for Medicaid claims involving inactive providers and determine an appropriate course of action; Enhance controls to prevent improper payments and Update guidelines to clarify billing requirements.

The Delaware County Chamber of Commerce has been awarded a 2 Year grant by Rural Health Network of South Central New York & their Getthere Mobility Management to plan and implement a micro-transit program to address unmet local transportation needs, Chamber President Ray Pucci explains:

(Ray Pucci 6-2-21)

The grant allows the Chamber to form public-private partnerships to potentially provide transportation for unserved and underserved populations who are without transportation for employment as well as for those who are not eligible for Medicaid, Medicare or senior transportation programs currently available through other outlets. More information is available at delawarecounty.org or 746-2281.

State Department of Health Commissioner Dr. Howard Zucker announced nursing homes in New York will be allowed to resume limited visitations for facilities that have been without COVID-19 for at least 14 days, a revision to the 28 day guidelines previously set by the federal Centers for Medicare & Medicaid Services. This updated guidance will allow eligible visitation in approximately 500 of the state’s 613 nursing homes. The guidelines go into effect Thursday; they require visitors to present a verified negative test result within the last seven days. More information is available at health.ny.gov/facilities.

The State Medicaid Redesign Team 2 will hold the third of a
series of public comment forums today beginning at 10:00 AM in Albany. The Team
is tasked with cutting about 2.5 billion dollars in costs to the program in the
next fiscal year's Budget; a live webcast of the public comment forum will be
available at health.ny.gov.

Governor Cuomo is hoping for the 2nd Medicaid Redesign team
to come up with savings as successful as the first Team did going back to 2011,
to close about 1/3 of the state projected budget gap for the next fiscal year,
Cuomo discussed that during his recent Budget Presentation in Albany:

(Cuomo 2-20-20)

The Medicaid Redesign Team #2 has had to preliminary
meetings last week, they are tasked with coming up with a solution to the out
of control costs, in time for the start of the next fiscal Year on April 1st.

State Comptroller Tom DiNapoli
released a report today regarding his analysis of the Governor's proposed 178
Billion Dollar Executive Budget.
DiNapoli said that there is significant fiscal challenges related to
higher than expected spending in the Medicaid program, more than a third of the
Executive’s proposed nearly $7 billion gap-closing plan remains to be
identified by the Medicaid Redesign Team that just started their work this
week.   The Comptroller's report is
located at osc.state.ny.us.

The State Health Department announced that for the week
ending February 8th, seasonal flu activity continues to be widespread across
the state for the 11th consecutive week.
There were 17,233 lab-confirmed flu cases, with a total of 106,824 cases
reported this season, with 3 flu-associated pediatric deaths. Last week, 1,993
New Yorkers were hospitalized with lab-confirmed influenza. So far this season,
there have been 15,541 flu-related hospitalizations.

The New York
Association of Counties held an advocacy day at the State Capitol to voice
concerns over changes to the Medicaid program contained in the Executive Budget
and to advocate for the maintenance of current local Medicaid caps.  The Association also wants the state to
maintain the 2% property tax cap, implemented by the Cuomo administration &
the State Legislature in 2012, which has slowed the increases in state property
taxes from previous annual double digit increase levels.

State Police arrested 51 year old
John Travis of Port Crane, for felony of Aggravated Unlicensed Operation, plus
DWI & False Personation.  A trooper
on Interstate 88 in the town of Fenton checked on a motorist who had pulled
over to the shoulder of the road,  Travis
appeared intoxicated & gave the trooper a fake name.  Travis was issued appearance tickets to the
town of Fenton court & was turned over to a sober third party.

The State Medicaid Redesign Team II will convene its first
meeting of all members today at the Albany Capital Center. The MRT II will
identify changes to the State's Medicaid program within the upcoming State
Budget.  The meeting will be open to the
public and streamed live online at health.ny.gov.

The proposed budget announced by Governor Cuomo this week
has a 6.1 billion dollar gap, about 1/3 of that from Medicaid Spending, Local
Assemblyman John Salka comments:

(John Salka 1-23-20)

Lawmakers have until April 1st to get a budget passed, the
budget proposed by the Governor total 173.8 Billion Dollars.

Governor
Cuomo will release his state budget plan Tomorrow afternoon which has a 6
Billion dollar projected budget gap due to the state taking over the Medicaid
costs from local governments over the last 6 years, he commented during his
State of the State address 2 weeks ago:

(Cuomo
1-20-20)

State
Comptroller Tom DiNapoli stated last week that the state too often relies on
moving deficits to out-year budgets, eventually it has to be dealt with.

Governor Cuomo told reporters
today that he will release his state budget plan next Tuesday afternoon, and he
will detail how he will deal with the 6 Billion dollar projected budget
gap.  Cuomo said that the budget gap is
largely due to overspending on Medicaid beyond the 2% per year spending cap.

The Chenango Arts Council will showcase the work of
recipients of 2019’s New York State Decentralization Grant Program in the
Mariea Brown and Raymond Loft Galleries.
The exhibit will feature visual and performing arts from regional arts
organizations and will open today at 5:30 pm.
It is free & open to the public at 27 West Main St, Norwich.  More information is available at 336-ARTS or
visit www.chenangoarts.org.

The latest financial report from the
Cuomo administration shows the state is facing a more than $6 billion budget
shortfall in the next fiscal year.  The
biggest spending growth is for Medicaid payments, where, in recent years, the
state has deferred some Medicaid expenses from one year to the next to balance
the books.  Governor Cuomo will outline
in January his plans to balance the next budget.

New York State paid more than $100 million in duplicate
payments to managed care organizations for premiums over a more than 4 year
period, according to an audit released today by State Comptroller Tom
DiNapoli.  Auditors found many cases of
people with multiple Client Identification Numbers, with Medicaid making
duplicate payments to those individuals.
DiNapoli recommended that the Department Of Health Review the $102.1
million in improper premium payments identified and make recoveries; Ensure
Local Districts make timely and accurate updates to information and evaluate
the feasibility of creating a control to prevent multiple Client ID Numbers
from being reused in the future. The report is available at
osc.state.ny.us/audits.

The
State Department of Health announced that a proposal for a new Medicaid model
of care serving children throughout the state with complex health needs has
been approved by the federal Centers for Medicare and Medicaid Services. The
new model will improve access to Medicaid services and expand Medicaid coverage
to home- and community-based care for more than 6,000 youth under age 21 who
are faced with an array of serious health issues and otherwise could be forced
to live in hospitals and other institutionalized settings.

The state’s Medicaid program paid more than $60,000 for
sexual and erectile dysfunction drugs and treatments for 47 sex offenders,
according to an audit by State Comptroller Tom DiNapoli.  DiNapoli recommended that the Department of
Health provide Managed Care Organization’s with detailed lists of all ED drugs,
procedures, and supplies that are excluded or have limited Medicaid coverage;
and take corrective actions to ensure compliance with laws, policies, and
procedures; and Improve Department of Health’s computer system to apply sex
offender status in the processing of claims.