BioReference Laboratories and Parent Company Agree to Pay $9.85 Million to Resolve False Claims Act Allegations of Illegal Remuneration to Referring Physicians

 

BOSTON – BioReference Health, LLC, formerly known as BioReference Laboratories, Inc., (BioReference) and OPKO Health, Inc. (OPKO) have agreed to pay $9.85 million to resolve alleged violations of the False Claims Act. The government alleges that BioReference rented office space from physicians and then paid those physician-landlords above-market rent so that the physicians would send their laboratory business to BioReference. BioReference, a subsidiary of OPKO, is headquartered in New Jersey and is one of the largest clinical laboratories in the United States.

Between January 2013 and March 2021, BioReference made lease payments to physicians and physician groups for the rental of office space for amounts that exceeded fair market value, in violation of the Physician Self‑Referral Law and the Anti-Kickback Statute.  The Physician Self‑Referral Law, commonly known as the Stark Law, prohibits a health care provider from billing for certain services referred by physicians with whom the provider has a financial relationship, unless that relationship satisfies one of the law’s statutory or regulatory exceptions. The Anti‑Kickback Statute prohibits offering or paying remuneration with the intent to induce the referral of items or services covered by Medicare, Medicaid, and other federally funded programs. Both the Stark Law and the Anti-Kickback Statute are intended to ensure that physicians’ medical judgments are not compromised by improper financial inducements.

As part of today’s settlement, BioReference admitted that it rented the office space from the specified physician practices for Patient Service Centers (PSCs) where patients could have their blood samples taken. In calculating payments under certain PSC lease arrangements, BioReference inaccurately measured the amount of space it would use exclusively and included a disproportionate share of common spaces. BioReference analyzed referrals from nearby health care providers—including physician-landlords—when deciding whether to open, maintain, or close PSCs. Following OPKO’s acquisition of BioReference, the companies conducted multiple internal audits that showed that the payments to the specified physician-lessors exceeded fair market value. BioReference did not report or return any overpayments to federal health care programs.

“Medical decisions by doctors should be based on what is best for each patient, not a doctor’s personal financial interest,” said United States Attorney Rachael S. Rollins. “When companies violate the federal health care laws that are meant to protect patients, health care costs for hard working people increase. We will continue to find fraud and use the False Claims Act to make companies that break the law pay back the taxpayers they defrauded as well as pay a financial price for their misconduct.”

“The integrity of federal health care programs depends on providers making decisions based on the interests of their patients,” said Principal Deputy Assistant Attorney General Brian M. Boynton, head of the Justice Department’s Civil Division. “The Department of Justice and its agency partners are committed to enforcing laws prohibiting illegal financial arrangements that may distort health care decision-making and drive up costs to federal health care programs and patients.”

In connection with the False Claims Act settlement, BioReference and OPKO have also entered into a five-year Corporate Integrity Agreement with the U.S. Department of Health and Human Services, Office of Inspector General, which provides for periodic reviews of BioReference’s processes, policies, and transactions for compliance with the Anti-Kickback Statute and the Stark Law by an Independent Review Organization. 

“This settlement is a warning to laboratories that think they can boost their profits by entering into improper financial arrangements with referring physicians,” said Special Agent in Charge Phillip M. Coyne of the U.S. Department of Health and Human Services, Office of Inspector General. “Working with our law enforcement partners, we will continue to crack down on such deals, which work to undermine impartial medical judgement, drive up health care costs, and corrode the public’s trust in the health care system.”

“Laboratories that scheme to enrich their businesses through health care fraud—such as by paying kickbacks—drive up health care costs for everyone,” said Joseph R. Bonavolonta, Special Agent in Charge of the FBI Boston Division. “This settlement shows how seriously the FBI takes its responsibility to weed them out, and we’d also like to thank the whistleblower in this case for helping us ensure these entities are held accountable.”

“When health care companies pay unlawful remuneration to physicians and submit false claims for improper referrals, they undermine the integrity of TRICARE and place an unnecessary financial burden on the program,” stated Special Agent in Charge Patrick J. Hegarty of the Defense Criminal Investigative Service, the law enforcement arm of the Department of Defense Office of Inspector General.  “The settlement agreement announced today demonstrates our ongoing commitment to work with our law enforcement partners to investigate healthcare fraud and protect TRICARE, the healthcare system for military members and their dependents.”

The False Claims Act allegations being resolved were originally brought in a lawsuit filed by a whistleblower under the qui tam provisions of the False Claims Act. Under those provisions, a private party can file an action on behalf of the government and share in any recovery.  In connection with today’s settlement, the whistleblower will receive 17 percent of the recovery. 

Under the settlement, the defendants will also pay approximately $145,000 to the Commonwealth of Massachusetts and the State of Connecticut to resolve alleged violations of their respective state False Claims Acts. 

U.S. Attorney Rollins, HHS-OIG SAC Coyne, FBI SAC Bonavolonta and DCIS SAC Hegarty made the announcement today. Assistant U.S. Attorneys Alexandra Brazier and Charles B. Weinograd of Rollins’s Affirmative Civil Enforcement Unit, and Trial Attorney Douglas Rosenthal of the Justice Department’s Civil Division, Commercial Litigation Branch, handled the matter.

Consumer Alert: New York State Division of Consumer Protection Offers Tips for Summer Travel

 

Secretary of State, Robert J. Rodriguez says, “Planning for Cancellations and Delays and Building More Time in Your Itinerary Could Save You Frustration and Money”

Watch Video Here

 

New Yorkers Should Know Their Rights and Follow Basic Tips to Avoid Travel Scams

 

Does Travel Insurance Really Work or Help? What You Should Know

The New York State Division of Consumer Protection (DCP) reminds New Yorkers of their rights as summer travel heats up. Travel disputes remain one of the top complaints handled by DCP. In 2021, DCP fielded hundreds of complaints from consumers who had to cancel or reschedule their travel plans due to COVID-19. As more New Yorkers are traveling again, consumers should be informed of their rights, shop smart to safeguard their hard-earned money, and stay vigilant to protect themselves from scams.

“With flight cancellations spiking and airports overcrowding, planning ahead, and being prepared is the best way to avoid travel headaches,” said Secretary of State Robert Rodriguez, who oversees the Division of Consumer Protection. “If you plan to use air travel to support your travel plans, planning for cancellations and delays and building more time in your itinerary could save you frustration and money.”

 

Superintendent of Financial Services Adrienne A. Harris said, “During the height of summer travel season, I urge all New Yorkers to review their travel rights and follow basic tips to avoid scams. The Department of Financial Services is collaborating with the Division of Consumer Protection (DCP) to ensure that New York travelers have accurate information as they make or amend their summer travel arrangements. The Department recommends that consumers read travel policies carefully before purchasing to fully understand what is covered if travel plans are disrupted.”

SHOPPING SMART FOR TRAVEL

 

There are basic travel tips that consumers should be aware of when they are booking travel:

• Plan & Expect Cancellations and Delays. Pack a change of clothes, electronic device chargers and snacks in your carry-on luggage to support travel disruptions. A cancellation that impacts your return home will require additional resources, budget for an extra day or two to sustain until you can get home.
  
  
• Book early morning tickets.You will have greater options for getting to your destination timely.
  
  
• Consider traveling to a larger airport.Larger metropolitan airports offer more direct flights than regional airports. Direct flights avoid missed connections and cancellations in a city outside of your hometown or destination.
  
  
• Do your research. Consumers should always weigh in the factors of a trip before purchase, including price, location, availability of activities and cancellation policies. Also consider whether the location has any Covid-19 restrictions in place, such as testing or vaccination status, prior to booking the trip. For a secure, digital copy of your vaccination record and/or negative COVID test result, you can retrieve your Excelsior Pass Plus here.
  
  
• Get all confirmations in writing. To safeguard against scams via changes in agreements, consumers should always get confirmation of plans in writing whether booking online, over the phone, or in person. Retailers are required to disclose terms and conditions to consumers—always receive a copy of the agreement and save it for reference.
  
  
• Beware of “all inclusive” or too good to be true offers. All-inclusive offers sound great but can have hidden charges and fees in their terms and conditions. Consumers may not even be aware of such fees until check-out when their bill is higher than advertised. Sometimes these offers come with an agreement to join a membership or participate in a presentation. Always inquire about mandatory fees that may not appear in the advertised price, such as resort fees and taxes. Read the fine print when taking advantage of an “all-inclusive” offer.
  
  
• Evaluate the benefits of paying by your credit cards.Credit cards often offer more protection than paying by cash, check or debit card. Some credit card companies also offer perks like trip insurance or concierge service while traveling and may offer additional protections if the trip is cancelled. Check with your credit card company on the conditions of travel expenditure reimbursement.
  
  
• Review your travel agreements. The New York State Truth in Travel Act safeguards consumers against fraud, false advertising, misrepresentation, and other abuses. Travel agents and promoters must provide consumers with written disclosures of all the terms of the travel service within five days of purchase or agreement. Consumers should review the terms of the agreements fully upon receipt and ensure they align with what the consumer purchased. Consumers have until midnight of the third business day after receiving the agreement to cancel. Consumers can also cancel any time during the five-day period prior to receiving the disclosures.
  
  
• Use reputable travel agents/tour companies. Consumers should research thoroughly before choosing an agent or company to work with. Keep track of arrangements and contracts, and review terms and conditions, especially the cancellation and refund policies. Reservations often require a deposit that may not be refundable. If the trip is cancelled, the deposit might only be applied toward future travel or may be forfeited altogether. Consumers should be sure they understand the policy prior to putting down a deposit.
  
  
• Consider trip insurance and whether you need a 'Cancel for Any Reason' policy.Travel insurance can offer consumers relief in case of emergency before or during their trip, as coverage ranges from incidents of lost baggage to missed connections to potential medical emergencies. However, most standard travel insurance policies do not cover trip interruption or cancellation due to COVID-19 because such standard policies usually exclude coverage for an epidemic, pandemic, or similar public health event. Some trip insurance plans offer ‘Cancel for Any Reason’ coverage at an additional cost, which is often substantially higher than standard travel insurance and normally only allows up to 75 percent refund of traveler expenses if the trip is cancelled.?Prior to purchasing a plan, review the terms of the policy and ask your insurer about coverage that may be excluded.

TRIP CANCELLATION

When all or part of a trip is cancelled, the cancellation policy and a consumer’s right to a refund will vary depending on the laws that regulate the company’s industry, who initiates the cancellation, when the cancellation is made, and the company’s own policy.

• According to the U.S. Department of Transportation, airlines must offer refunds, including the ticket price and any optional fees charged, for cancelled or significantly delayed flights, even when flight disruptions are outside their control. If an airline isn’t doing that, consumers should report it to the U.S. Department of Transportation. If consumers cancel a reservation for any reason, consumers will be subject to the refund policy agreed to at the time of purchase, which may be no refund at all.
  
  
• Cruise Lines. Refund options may vary by cruise line. The cruise ticket contract lays out the company’s cancellation policies and your rights. For example, you may be offered a refund, credit, or voucher for a future cruise. If you opt for a credit or voucher, make sure the expiration date is far enough out that you can use it. Read more from the Federal Maritime Commissionabout consumer rights and the recourse that might be available to you.
  
  
• Cancellation policies for hotels, motels, and online accommodation marketplaces can vary greatly, even within the same company based on the season, room type, or length of stay. Some may offer a choice between a refundable or nonrefundable rate while making the reservation. Be sure you fully understand the cancellation policy prior to making a reservation.
  

If a consumer is having trouble getting a refund owed for all or part of a cancelled trip, they are encouraged to file a complaint with DCP.

SIGNS OF A TRAVEL SCAM

The Federal Trade Commission warns against common travel scams. Some signs of a scam when booking travel include the following:

• You have “won” a free vacation. Scammers will sometimes entice consumers with a free trip, but then disclose fees or deposits to get access. A prize should not include spending money and is likely a scam.
  
  
• The details of your trip are vague. Consumers may be offered a stay in a five-star hotel or on a luxury cruise line, but then few details about the trip are presented. Always confirm and review the name of the company and location of the trip details.
  
  
• You have limited time to accept the offer.Scammers often pressure consumers to make quick decisions about a deal, making it likely that the consumer will not have time to investigate the offer. Never feel pressured to agree to any terms you have not reviewed on your own.
  
  
• You must pay in an uncommon way. Cryptocurrency, wire transfers, and gift cards are difficult to trace and perfect for scammers looking to take advantage of consumers. These types of payments make it difficult for consumers to recoup their losses. If a travel company insists that you pay in one of these ways, decline the offer and report the company.
  

The New York State Division of Consumer Protection provides voluntary mediation between a consumer and a business when a consumer has been unsuccessful at reaching a resolution on their own. The Consumer Assistance Helpline 1-800-697-1220 is available Monday to Friday from 8:30am to 4:30pm, excluding State Holidays, and consumer complaints can be filed at any time at www.dos.ny.gov/consumerprotection. 

Travel insurance is regulated by the Department of Financial Services. Consumer with complaints about travel insurance policy or ‘Cancel for Any Reason’ coverage issued in New York or by New York companies should contact DFS at www.dfs.ny.gov/complaint or through the DFS Consumer Hotline at (800) 342-3736 (212) 480-6400 or (518) 474-6600 (Monday through Friday, 8:30 AM to 4:30 PM).

For more consumer protection tips, follow the Division on social media at Twitter: @NYSConsumer and Facebook: www.facebook.com/nysconsumer.

DEC Issues Fire Danger Reminder - A Dry Summer Increases Risk for Wildfires

 

New York State Department of Environmental Conservation (DEC) Commissioner Basil Seggos today urged New Yorkers to practice the utmost safety when building campfires this summer. Dry weather throughout June and July has increased the risk of fires.

 

“The sunny, summer weather is giving people ample opportunity to enjoy New York’s outdoors, but it’s also increasing the risk for fires,” Commissioner Seggos said. “When building a campfire, please make sure to always keep an eye on it and pay attention to the wind. And when finished, make sure the fire is fully out and cold to the touch.”

 

The majority of the state remains at a moderate risk for fires, meaning that any outdoor fire can spread quickly, especially if the wind picks up. Campfires are among the top five causes of wildfires.

 

DEC continues to encourage New Yorkers and visitors to follow the recommendations below to reduce the risk of wildfires.

 

While camping in the backcountry, New Yorkers are advised to:

• Use existing campfire rings where possible;
• Build campfires away from overhanging branches, steep slopes, rotten stumps, logs, dry grass, and leaves. Pile extra wood away from the fire;
• Clear the area around the ring of leaves, twigs, and other flammable materials;
• Never leave a campfire unattended. Even a small breeze could cause the fire to spread quickly; and
• Drown the fire with water. Make sure all embers, coals, and sticks are wet. Move rocks as there may be burning embers underneath.

Fire safety tips for burning wood or brush:

• Never burn on a windy day;
• Check and obey all local laws and ordinances;
• Burn early in the morning when humidity is high and winds are low;
• Clear all flammable material for a distance of 10 to 15 feet around the fire;
• Keep piles to be burned small, adding small quantities of material as burning progresses;
• Always have a garden hose, shovel, water bucket, or other means to extinguish the fire close at hand; and
• When done, drown the fire with water, making sure all materials, embers, and coals are wet.

Do not burn household trash:

• Burning trash is prohibited statewide in all cases. Incinerator rules prohibit burning household trash in wood stoves, fireplaces, and outdoor wood boilers;
• DEC recommends recycling all appropriate materials (such as newspaper, paper, glass and plastic) and composting organic kitchen and garden waste;
• Burning leaves also is banned in New York State. DEC encourages composting of leaves; and
• Disposal of flags or religious items in a small-sized fire is allowed if it not otherwise prohibited by law or regulation.

For information on open burning and campfire safety in New York, go to DEC's Open Burning in New York and Fire Safety When Camping webpages.

 

For further questions about wildfires, call 1-833-NYS-RANGERS and call 911 to report a wildfire.

MAYOR ADAMS UNVEILS PHASE ONE OF “NYC FERRY FORWARD,” VISION FOR A MORE EQUITABLE, ACCESSIBLE, FISCALLY SUSTAINABLE SYSTEM

 

New Fair Fares-Style NYC Ferry Discount Program Will Make System More Equitable, Lower Prices for Low-Income Riders, Seniors, and People With Disabilities

 

New, Progressive Fare Structure Will Help Reduce Public Subsidy

 

Elimination of Bike Fee, Additional Outreach to NYCHA Residents, Support for Alternative Payment Methods Will Help Attract Riders

 New York City Mayor Eric Adams today unveiled “NYC Ferry Forward,” his vision for a more equitable, accessible, and fiscally sustainable citywide ferry system. The plan includes a new NYC Ferry Discount Program — modeled after the city’s Fair Fares program for subways and buses, which offers reduced-fair rides for seniors, people with disabilities, and low-income riders. Starting in September, a at least 1 million - New Yorkers can take advantage of the program and ride the ferry, one way, for the low price of $1.35. The plan also features a new, progressive fare structure, free trip vouchers and expanded outreach to NYCHA residents, makes it easier for New Yorkers to bike to and from the ferry, and creates opportunities for revenue generation.

 

“Getting around New York City shouldn’t feel like you’re running a 5K. Wherever you live in the five boroughs, we want you to have choices, and our vision for the NYC Ferry helps provide New Yorkers with those choices,” said Mayor Adams. “More and more New Yorkers are now using the NYC Ferry to get to work and get around, so we are writing a new chapter in the history of the NYC Ferry system and of transportation in our city — one built on the three pillars of equity, accessibility, and fiscal sustainability. Our NYC Ferry Forward vision will keep our city on the map as a leader and innovator in public transportation.”

 

“NYC Ferry not only connects waterfront communities long underserved by mass transit, but it has also proved to be a boon for small businesses in the neighborhoods it serves,” said Deputy Mayor for Economic and Workforce Development Maria Torres-Springer. “The NYC Ferry Forward plan will make the system more equitable, accessible, and financially sustainable. I thank the mayor for his vision, the EDC team for their stewardship of the system to date, and the work put into evolving the system to better serve New Yorkers and our communities.”

 

“We welcome all New Yorkers to experience NYC Ferry,” said New York City Economic Development President and CEO Andrew Kimball. “Under Mayor Adams’ new plan, we are prioritizing equity by reducing fares for lower-income riders, seniors, and people with disabilities, and we are launching new fare polices to optimize our cost structure, while exploring new opportunities to generate revenue. We are committed to improving NYC Ferry, so it operates more efficiently and continues to connect millions of New Yorkers to jobs, schools, recreation, and our waterfront communities.”

 

Eligible New Yorkers will be able to apply for the Ferry Discount Program using the NYC Ferry website or by mailing in an application. Once verified, eligible riders can buy discounted tickets through the NYC Ferry app or at NYC Ferry ticket windows and agents. The NYC Ferry app will also support digital wallet apps like Cash App to expand access for more New Yorkers. A discounted one-way ticket price of $1.35 will help to make the ferry accessible to even more New Yorkers, while also helping to diversify NYC Ferry's ridership.

 

To help more New Yorkers to apply for the Ferry Discount Program, NYC Ferry will send mailers this summer to almost 60 New York City Housing Authority (NYCHA) developments within about one mile of each ferry landing, ahead of the program’s launch. Additionally, NYC Ferry in partnership with NYCHA and other community organizations to conduct targeted and ongoing outreach to NYCHA residents and offer two free NYC Ferry app tickets to encourage first time riders to explore and enjoy the ferry. The plan also focuses on increasing revenue and ridership by establishing a new, dynamic, and progressive fare structure, which reduces costs to the city. This means keeping the cost low for regular riders, while asking infrequent riders to pay a little more. The plan ensures everyday riders can still take advantage of the $2.75 fare by purchasing aa 10-trip pack for $27.50, while single ride fares will cost $4.00 for visitors or infrequent riders. This scale will allow the system to continue to best serve riders, while generating as much as $2 million in additional annual revenue, helping to reduce the system’s public subsidy.

 

Mayor Adams will also eliminate the $1.00 bike fee across the entire NYC Ferry system to help encourage environmentally sustainable multi-modal transportation. Now, New Yorkers are more encouraged to bike to and from the ferry, while also taking a mode of transportation that decreases commuters’ reliance on cars and simultaneously reducing the city’s carbon footprint. The elimination of the $1.00 bike fee and fare changes take effect on September 12, 2022. The city will be working with NYC Ferry operator City Experiences to implement these initiatives over the coming weeks.

 

“The NYC Ferry Forward plan is a needed and innovative step toward achieving a ferry system that is deeply accessible while also fiscally sustainable. I have worked closely with President Andrew Kimball and the team at EDC to make sure that we were keeping what was already great, while also thinking creatively and proactively on how to lower costs, increase ridership, and keep the ferries affordable for everyone,” said Council Member Amanda Farías, chair, Committee on Economic Development. “Thank you to Mayor Eric Adams for prioritizing affordability for the riders as well as the city’s pockets and to President Andrew Kimball for your commitment to improving our ferry system throughout these last seven months. I look forward to continuing to work together on the success of our NYC Ferry system.”

 

“I applaud the New York City Economic Development Corporation for unveiling a new plan for the NYC Ferry focused on equity and access for all New Yorkers,” said Bronx Borough President Vanessa Gibson. “For too long residents living in transportation deserts have faced long commutes each day lasting well over an hour each way. Yet, since its launch in Soundview in 2018, straphangers have seen their commutes decrease. With up to 35% of NYC Ferry riders from the Bronx, it is clear this program will benefit even more under this plan by allowing our NYCHA residents to ride for free and eliminating the $1 charge to bring your bike on board. This proposal is a step forward towards transit equity, financial sustainability, and to giving more of our residents access to our beautiful waterways.” 

 

In an effort to generate new revenue and continue increasing ridership, NYC Ferry will launch the Rockaway Rocket this month. The new, reservation-based shuttle pilot program with direct service from Pier 11 in Lower Manhattan to Rockaway. The shuttle will run on summer weekends and holidays from July 23 until Labor Day weekend, supplementing the current NYC Ferry service on the Rockaway route. Additionally, NYC Ferry will work to generate additional revenue by seeking new public-private sponsorship opportunities and developing a plan to maximize revenue from any underused vessels, including for film or TV productions. These opportunities will further reduce system costs and public subsidies in the future.

 

Additionally, New York City Economic Development Corporation (NYCEDC), which oversees NYC Ferry, will initiate a competitive, open bidding process for a new ferry operation contract this summer. This new contract will further allow the system to remain a permanent fixture of the New York City landscape.

 

The NYC Ferry system provides more than 6 million riders annually with safe, dependable, affordable, and accessible transit across the five boroughs. With six routes that touch every borough, 25 landings, and 38 vessels, the system spans 70 nautical miles and is now the largest passenger-only fleet in the nation, based on hours of service. NYC Ferry has further proven to be among New York City’s most resilient transit network with the fastest ridership recovery of any city transit system since the pandemic.

 

“Ferries are zipping around New York Harbor and local waterways reaching new corners of New York City and connecting communities, opening new recreational opportunities, and shortening commutes. We commend Mayor Adams and EDC for envisioning the next chapter of NYC Ferry’s growth by supporting revenue generation through a variety of new farebox collection options with equitable and fair ticketing for commuters,” said CEO and President of The Waterfront Alliance Cortney Worrall. “There is great opportunity to expand services to new locations, to identify transit deserts that would be well-served by ferries, and to increase revenue through new advertising, concessions, and partnerships. We urge the city and transit advocates to continue to comprehensively understand the benefits of New York City’s ferry system.”

 

“NYC Ferry connects communities across the city,” said Urban Upbound President and CEO Bishop Mitchell Taylor, “With the fare discounts and public engagement outlined in the NYC Ferry Forward plan, a greater number of New Yorkers will have the opportunity to benefit from the ferry’s links to where they work, where they live, and spaces for recreation. I applaud NYCEDC, NYC Ferry, and Mayor Adams on launching this next chapter for the ferry system and placing equity at its center.”

Governor Hochul Announces Charging Discount Programs for Electric Vehicle Drivers Across New York

 

PSC Approves 'Managed Charging' Programs Providing EV Drivers with Bill Discounts When Charging During Beneficial Times for the Grid

PSC Advances 'EV Make-Ready' Program to Accelerate Deployment of 50,000 Public and Commercial Charging Ports — Including 1,500 Fast-Charging Ports — by 2025

 Governor Kathy Hochul today announced that the State Public Service Commission approved New York's investor-owned utilities electric vehicle active and passive-managed charging programs, a key element in further developing New York's electric vehicle infrastructure. Today's PSC decision is an integral part of the initiative known as the EV Make-Ready program which directed the utilities to develop managed charging programs that will provide customers with an alternative to the whole home Time-of-Use rates that are already in place. Managed charging programs and TOU rates incentivize charging at the most beneficial times for the grid, which has the potential to extend the estimated societal benefits of EV deployments to more than $5 billion through 2030. 

"I am proud to say New York leads the nation in clean energy innovation to combat climate change and bring environmental justice to impacted communities," Governor Hochul said. "Today's action brings us one step closer to a greener, emission-free future, and expand upon the benefits of electric vehicle ownership by providing added savings at a time when New Yorkers need it the most."

The EV Make-Ready program provides funding for the infrastructure required to support more than 50,000 new public and commercial Level 2 charging ports, capable of charging a vehicle at least two times faster than a standard wall outlet, and 1,500 public DC (direct current) fast charger ports in New York in recognition of the essential role that public fast charging ports will play in the near term to allay range anxiety. Before the program began, there were 4,571 publicly accessible chargers statewide. This program will increase the number of publicly accessible chargers in New York State more than tenfold.

The EV Make-Ready program is funded by major investor-owned utilities in New York State and creates a cost-sharing program that incentivizes utilities and charging port developers to site electric vehicle charging infrastructure in places that will provide a maximal benefit to consumers. The Commission capped the total budget at $701 million and it will run through 2025, with a minimum of $206 million allocated toward equitable access and benefits for lower-socio-economic and disadvantaged communities. EV charging ports in disadvantaged communities are eligible for a higher incentive, supporting up to 100 percent of the costs to make a site ready for EV charging.

Encouraging private investment in publicly accessible fast-charging ports will stimulate the EV market in New York over the coming years. While the initial focus was on funding projects located in communities served by investor-owned utilities, the Commission said that the objectives to advance the state's transportation electrification goals, expand access to clean transportation, and reduce emissions in disadvantaged communities are relevant across the entire state.

Public Service Commission Chair Rory M. Christian said, "As the adoption of EVs increases throughout the State, well-designed EV managed charging programs will provide essential benefits to the utility and transportation sectors. By providing EV drivers with incentives for beneficial charging behavior, along with resources that makes charging hassle-free, the managed charging programs will create a win-win for EV drivers in the form of lower fuel costs and the grid in the form of reduced infrastructure costs."

Today's decision impacts customers of the major utilities in New York State — Central Hudson Gas & Electric Corporation, Consolidated Edison Company of New York, Inc., New York State Electric & Gas Corporation, National Grid, Orange and Rockland Utilities, Inc. and Rochester Gas and Electric Corporation.

The transportation sector is responsible for the largest contribution to greenhouse gas pollution in the country, with these emissions increasing more than any other sector over the last 30 years. Encouraging accelerated, forward-thinking development of charging infrastructure will provide New Yorkers with more than $2.6 billion in net benefits and supports the achievement of the State's transportation electrification and clean energy goals. Electrifying transportation will allow New Yorkers to power vehicles with cleaner energy sources, with renewables representing a growing portion of the state's electricity supply. Thoughtful siting of charging infrastructure will support reduced installation costs, improve site host-acceptance and maximize use from drivers.

In a related development, the PSC modified the EV rules for Con Edison, the state's largest electric utility. Specifically, the PSC will allow Con Edison to increase the current single-site plug limit on fast-charging stations from 10 plugs to 30 plugs and it will eliminate the funding limit on certain incentives. The modifications will alleviate market constraints to increase charging station accessibility by facilitating developer interest and market growth in the company's service territory, including expanded access for disadvantaged communities.

The Long Island Power Authority (LIPA), with its service provider, PSEG Long Island, has announced a goal to support 180,000 new EVs on Long Island with 4,745 new EV charging ports by 2025, with a proposed investment of $89 million in make-ready infrastructure over the next four years.

Customers on Long Island and other regions of New York State that fall outside of the investor-owned utility service territories can leverage the innovative prize competition design and administrative capabilities developed by NYSERDA for the "New York Clean Transportation Prizes".

The PSC's objectives to advance the state's transportation electrification goals, expand access to clean transportation, and reduce emissions in disadvantaged communities should be pursued by all communities throughout the state, without regard to the particular electric service provider or regulatory framework that governs that service, and a coordinated, statewide approach is needed to meet the Climate Leadership and Community Protection Act (CLCPA) requirements, and that all New Yorkers should share in the benefits of the CLCPA.

The CLCPA includes the requirements that all state agencies prioritize greenhouse gas emissions reductions in disadvantaged communities and that no less than 35 percent of the overall benefits of spending on clean energy programs benefit disadvantaged communities. EV Make-Ready costs include utility-owned make-ready work, customer-owned, make-ready work, make-ready implementation and other programs costs.

New York State's Nation-Leading Climate Plan

New York State's nation-leading climate agenda is the most aggressive climate and clean energy initiative in the nation, calling for an orderly and just transition to clean energy that creates jobs and continues fostering a green economy as New York State recovers from the COVID-19 pandemic. Enshrined into law through the Climate Leadership and Community Protection Act, New York is on a path to achieve its mandated goal of a zero-emission electricity sector by 2040, including 70 percent renewable energy generation by 2030, and to reach economy wide carbon neutrality. It builds on New York's unprecedented investments to ramp-up clean energy including over $35 billion in 120 large-scale renewable and transmission projects across the state, $6.8 billion to reduce buildings emissions, $1.8 billion to scale up solar, more than $1 billion for clean transportation initiatives, and over $1.6 billion in NY Green Bank commitments. Combined, these investments are supporting nearly 158,000 jobs in New York's clean energy sector in 2020, a 2,100 percent growth in the distributed solar sector since 2011 and a commitment to develop 9,000 megawatts of offshore wind by 2035. Under the Climate Act, New York will build on this progress and reduce greenhouse gas emissions by 85 percent from 1990 levels by 2050, while ensuring that at least 35 percent with a goal of 40 percent of the benefits of clean energy investments are directed to disadvantaged communities, and advance progress towards the state's 2025 energy efficiency target of reducing on-site energy consumption by 185 trillion BTUs of end-use energy savings.

NYS Office of the Comptroller DiNapoli Audit Finds Lax Oversight of Medicaid Payments May Have Cost Taxpayers Nearly $300 Million

 

Audit Finds No Attempt to Recover $292 Million in Overpayments for Recipients With Third-Party Insurance Coverage

 Too often Medicaid pays medical bills that a third-party insurer should have covered, and not enough is being done to make sure Medicaid recovers that money, according to an audit by New York State Comptroller Thomas P. DiNapoli. The audit found that a lack of oversight by the state Department of Health (DOH) and the Office of the Medicaid Inspector General (OMIG) resulted in nearly $300 million in pharmacy claims that Medicaid never tried to recover from patients’ insurance providers.

“Medicaid is essential for millions of New Yorkers, but the program needs to ensure that funding is only used for appropriate costs for those who need it,” said Comptroller DiNapoli. “This is my office’s latest audit to uncover weaknesses in the Medicaid system’s oversight. These potentially unnecessary payments likely contributed to significant waste and a missed opportunity to recover the nearly $300 million in questionable payments. DOH should recoup any overpayments and take steps to better protect taxpayers from costly billing mistakes.”

The New York State Medicaid program provides a wide range of medical services to many New Yorkers, including those with lower incomes and/or people with special health care needs. As of the close of the State’s fiscal year on March 31, 2022, New York’s Medicaid program had served approximately 7.8 million recipients and Medicaid claim costs totaled about $74.6 billion.

Per federal law and state regulations, Medicaid is always the payer of last resort. This means that if a Medicaid recipient has third-party health insurance (TPHI) coverage, then those third-party benefits must be exhausted before the Medicaid program is billed.

To address instances where a TPHI should have paid instead of Medicaid, the DOH – in partnership with OMIG and Health Management Systems, Inc. (HMS) -- utilizes post-payment reviews. Auditors found that weaknesses in DOH’s and OMIG’s oversight of HMS’ payment reviews likely contributed to significant waste and a missed opportunity to recover improper payments.

Between October 2015 and May 2020, auditors identified drug claims paid by Medicaid managed care plans totaling $292 million for which HMS did not bill claims to TPHI carriers for recovery, despite the individuals having third-party drug coverage. For instance, nearly $40 million was paid for Medicaid recipients with Medicare Part D coverage and for covered medications provided at in-network providers – a scenario that is very likely the responsibility of Medicare, not Medicaid, and that should have been refunded to the state. Also, auditors presented a sample of 50 (which included high-cost drugs) to OMIG and HMS for their review and asked for an explanation as to why they were not billed to the TPHI carrier. HMS was unable to determine why most of these claims – 38 out of 50 – were not recovered, and for another 9 out of 50, auditors found the explanations were not justified.

According to HMS officials, internal processes are not set up to track why individual claims are excluded from the recovery process. Auditors determined that without proper oversight and this level of tracking, there is no way to ensure that all appropriate recoveries are being made. Also concerning, HMS did not have comprehensive reports of its activities available upon auditors’ request. DiNapoli’s audit recommended:

• A review of the $292 million in Medicaid payments made on behalf of recipients with TPHI identified by the audit to ensure overpayments are appropriately recovered;
• An assessment of pharmacy claims that were billed to TPHI carriers but did not result in recovery of payment to ensure that proper steps are taken to obtain recoveries where appropriate;
• An assessment of the third-party liability recovery process for managed care pharmacy services and implementation of corrective actions where necessary; and,
• Implementation of ongoing monitoring of the TPHI recovery process for managed care pharmacy services to ensure that all appropriate recoveries are made within the statute of limitations.

In response to our audit, officials stated that all claims are reviewed as part of existing processes. However, officials acknowledged that they are working on enhancements to the entire recovery process, which will include developing additional reporting to give OMIG greater insight into why claims were not billed to TPHI carriers for recovery.

Report:

Medicaid Program: Recovering Managed Care Overpayments for Pharmacy Services on Behalf of Recipients With Third-Party Health Insurance