Federal Reports

We found that the Department was complying with appropriate guidance and requirements and appeared to be on track for meeting its milestones. We did not find any evidence to indicate that the Department was not on track for implementing DATA Act reporting requirements by the May 2017 deadline. We did, however, note that the Department could improve its project management process. Specifically, we found that the Department lacked a designated project manager for its DATA Act implementation efforts, as well as applicable project documentation regarding work performed. These weaknesses may increase the risk of erroneous decision-making and future implementation delays.

The New York State Department of Health claimed Federal Medicaid reimbursement for dental services billed by a Westchester County dentist that did not always comply with certain Federal and State requirements. Of the 100 randomly selected beneficiaries that we reviewed, claims associated with 78 beneficiaries complied with Federal and State requirements. However, claims for the remaining 22 beneficiaries did not comply with Federal and State requirements. For 14 of these 22 beneficiaries, the dentist who performed the services was not enrolled in the Medicaid program because their Medicaid enrollment status was not verified prior to the services being provided. For services provided to eight other beneficiaries, the Westchester County dentist did not provide documentation to support services billed. On the basis of our sample results, we estimated that the State agency claimed at least $84,000 in Federal reimbursement for unallowable dental services billed by the Westchester County dentist.

The New York State Department of Health claimed Federal Medicaid reimbursement for dental services billed by a Queens dentist that did not always comply with certain Federal and State requirements. Of the 100 randomly selected beneficiaries that we reviewed, claims associated with 67 beneficiaries complied with Federal and State requirements. However, claims for the remaining 33 beneficiaries were unallowable because the dentist who performed the services was not enrolled in the Medicaid program. On the basis of our sample results, we estimated that the State agency claimed at least $82,000 in Federal reimbursement for unallowable dental services billed by the Queens dentist.

Not all of the Commonwealth of Puerto Rico's Department of the Family's (State agency) controls for provider and client eligibility determinations were effective. Specifically, all of the provider eligibility controls we tested for provider background checks, required provider forms, and provider rate agreements were not effective. Of the client eligibility controls we tested, we determined that the State agency's controls for family income and need-for-service eligibility were not effective. Although we found that the State agency's controls for verifying clients' citizenship were effective, we identified that the State agency was not implementing Federal law regarding client eligibility. Specifically, the State agency was not considering qualified aliens eligible for childcare services. Finally, the State agency's controls for client age and claim processing that we tested were effective.

The Centers for Disease Control and Prevention awarded all 31 selected Ebola-related international grants totaling $122 million in accordance with applicable laws, regulations, and departmental guidance.