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Medicaid Program – Improper Payments for Recipients No Longer Enrolled in Managed Long Term Care Partial Capitation Plans
… inappropriate capitation payments to Managed Long Term Care Partial Capitation plans for recipients who were no … through January 31, 2015. Background Managed Long Term Care Partial Capitation plans (Plans) provide health and long-term care services to recipients who have a long-lasting health …
https://www.osc.ny.gov/state-agencies/audits/2016/03/30/medicaid-program-improper-payments-recipients-no-longer-enrolled-managed-long-term-careAssessment of Costs to Administer the Workers’ Compensation Program for the Fiscal Year Ended March 31, 2014
… Purpose The purpose of this performance audit is to determine whether the Workers’ Compensation Board (Board) has adequate procedures in place to accurately report its assessable expenses related to the administration of Sections 50(5) and 151 of the … The purpose of this performance audit is to determine whether the Workers Compensation Board Board has …
https://www.osc.ny.gov/state-agencies/audits/2016/10/26/assessment-costs-administer-workers-compensation-program-fiscal-year-ended-march-31-2014DiNapoli and Brooklyn D.A. Gonzalez: Public Employee Arrested for Using Co-Workers' Identities to Steal Thousands in Gas
… his personal use, State Comptroller Thomas P. DiNapoli and Brooklyn District Attorney Eric Gonzalez announced today. … said State Comptroller Thomas P. DiNapoli. "I thank Brooklyn District Attorney Eric Gonzalez for partnering with … at a heavy cost to taxpayers over the long term," said Brooklyn District Attorney Eric Gonzalez. "I commend …
https://www.osc.ny.gov/press/releases/2018/06/dinapoli-and-brooklyn-da-gonzalez-public-employee-arrested-using-co-workers-identities-stealFar Rockaway Pre-School Provider "Investor" Pleads Guilty in Theft of Education Funds Intended for Special Needs Students
… Thomas P. DiNapoli and Queens District Attorney Richard A. Brown today announced that a self-described investor in … Thomas P. DiNapoli said. "I thank District Attorney Brown for this fourth and final guilty plea in the $12.4 … and his three co-defendants," said District Attorney Brown. "The public funds provided to Island Child Development …
https://www.osc.ny.gov/press/releases/2017/04/far-rockaway-pre-school-provider-investor-pleads-guilty-theft-education-funds-intended-special-needsMedicaid Program – Ambulatory Patient Groups Payments for Duplicate Claims and Services in Excess of Medicaid Service Limits
… Patient Groups (APG) payment methodology. The audit covered the period from December 1, 2008 through May 29, … methodology in an effort to pay providers more accurately for their services. APG claims are reimbursed based on patient condition and complexity of …
https://www.osc.ny.gov/state-agencies/audits/2015/06/29/medicaid-program-ambulatory-patient-groups-payments-duplicate-claims-and-services-excessComptroller DiNapoli, Manhattan D.A. Bragg Announce Guilty Plea of Former NYU Director of Finance for Major Fraud
… Jr. today announced the guilty plea of CINDY TAPPE, 57, for orchestrating an approximately $3.5 million 6-year fraud … her position as the Director of Finance and Administration for NYU’s Metropolitan Center for Research on Equity and Transformation of Schools (the …
https://www.osc.ny.gov/press/releases/2024/02/comptroller-dinapoli-manhattan-da-bragg-announce-guilty-plea-former-nyu-director-finance-major-fraudDiNapoli: Former Medical Office Manager Arrested for Scheme to Defraud the New York State Health Insurance Plan
… with Ulster County District Attorney Clegg and the Federal Bureau of Investigation this health care fraud was … will be held accountable.” Gina Bradshaw, 50, of Maybrook, NY, worked as an office manager for multiple doctors in … the employee from NYSHIP. The employee must then pay the provider out of pocket either with their own funds or by …
https://www.osc.ny.gov/press/releases/2023/09/dinapoli-former-medical-office-manager-arrested-scheme-defraud-new-york-state-health-insurance-planDiNapoli: Former Throop Supervisor Pays Full Restitution After Pleading Guilty to Felony for Stealing $11,000 from Town
… as part of his sentencing after pleading guilty to stealing $11,000 from the town, State Comptroller Thomas … State Police announced today. William Tarby pleaded guilty to grand larceny and official misconduct in January, and as … New York State Police for their work in partnering with us to bring him to justice. My office will continue to work with …
https://www.osc.ny.gov/press/releases/2024/02/dinapoli-former-throop-supervisor-pays-full-restitution-after-pleading-guilty-felony-stealing-11000Selected Payments for Special Items Made to St. Mary's Hospital from January 1, 2011 through March 31, 2011
… district employees and their dependents. The Empire Plan (Plan) is the primary health benefits plan for NYSHIP. … in accordance with agreements they negotiate with member hospitals, including St. Mary’s. Empire’s payments to St. … costs to acquire them. Key Findings We reviewed one claim payment to St. Mary’s for special items and determined Empire …
https://www.osc.ny.gov/state-agencies/audits/2013/02/01/selected-payments-special-items-made-st-marys-hospital-january-1-2011-through-march-31-2011Medicaid Program – Recovering Managed Care Overpayments for Pharmacy Services on Behalf of Recipients With Third-Party Health Insurance
… (MCOs) a monthly premium for each enrolled recipient, and in turn, the MCOs are required to pay for the Medicaid … recipients have other third-party health insurance (TPHI) in addition to Medicaid (e.g., employer-based coverage or … bill TPHI carriers for the recovery of about $292 million in pharmacy claims that MCOs paid as the primary insurance …
https://www.osc.ny.gov/state-agencies/audits/2022/07/13/medicaid-program-recovering-managed-care-overpayments-pharmacy-services-behalf-recipientsSelected Payments for Special Items Made to St. Peter's Hospital from January 1, 2011 through March 31, 2011
… Purpose To determine if BlueCross BlueShield's (Empire's) payments to St. Peter's Hospital (St. Peter's) for special items were … To determine if BlueCross BlueShields Empires payments to St …
https://www.osc.ny.gov/state-agencies/audits/2013/02/01/selected-payments-special-items-made-st-peters-hospital-january-1-2011-through-march-31Selected Payments for Special Items Made to Mount Sinai Hospital from January 1, 2011 through March 31, 2011
… determine if BlueCross BlueShield's (Empire's) payments to Mount Sinai Hospital (Mount Sinai) for special items were made according to the provisions of the agreement between Empire and Mount Sinai. Background The New York State Health Insurance …
https://www.osc.ny.gov/state-agencies/audits/2013/02/01/selected-payments-special-items-made-mount-sinai-hospital-january-1-2011-through-march-31Selected Payments for Special Items Made to Albany Medical Center from January 1, 2011 through March 31, 2011
… Purpose To determine if BlueCross BlueShield’s (Empire’s) payments to Albany Medical Center (AMC) for special items were made … To determine if BlueCross BlueShields Empires payments to Albany Medical Center AMC for special items were made …
https://www.osc.ny.gov/state-agencies/audits/2013/02/01/selected-payments-special-items-made-albany-medical-center-january-1-2011-through-march-31Identifying, Reporting, and Providing Services for Youth at Risk of Sexual Human Trafficking in New York City
… and Strengthening Families Act, which requires the screening of children within the child welfare system for … adequate services, such as safe housing and medical, mental health, legal, educational, and/or vocational assistance. Key …
https://www.osc.ny.gov/state-agencies/audits/2022/06/06/identifying-reporting-and-providing-services-youth-risk-sexual-human-trafficking-new-yorkSelected Payments for Special Items Made to Arden Hill Hospital From January 1, 2011 Through March 31, 2011
… Purpose To determine if BlueCross BlueShield’s (Empire’s) payments to Arden Hill Hospital (Arden Hill) for special items were … To determine if BlueCross BlueShields Empires payments to Arden Hill Hospital Arden Hill for special items were made …
https://www.osc.ny.gov/state-agencies/audits/2013/02/01/selected-payments-special-items-made-arden-hill-hospital-january-1-2011-through-march-31Medicaid Program – Improper Medicaid Payments for Claims Not in Compliance With Ordering, Prescribing, Referring, and Attending Requirements
… Objective To determine whether the Department of Health (Department) paid for claims in violation of … To determine whether the Department of Health paid for claims in violation of federal and State …
https://www.osc.ny.gov/state-agencies/audits/2021/08/17/medicaid-program-improper-medicaid-payments-claims-not-compliance-ordering-prescribingDiNapoli: Former Tax Collector Accused of Pocketing $88,000 for Car Loans, Amazon Purchases, Food and Other Expenses
… New York State Comptroller Thomas P. DiNapoli today announced the … Dutchess County D.A. William Grady and the New York State Police. “While people across the state struggled to deal with the economic impact of the … New York State Comptroller Thomas P DiNapoli today announced the …
https://www.osc.ny.gov/press/releases/2021/03/dinapoli-former-tax-collector-accused-pocketing-88000-car-loans-amazon-purchases-food-and-otherSelected Aspects of Leasing Practices for Real Estate Department, Aviation, World Trade Center, and Leasing of Properties
… Bridge Bus Station, and the World Trade Center. PANYNJ’s real estate portfolio consists of over 12,000 acres of land … June 2014 through November 2019. This amount included money due to PANYNJ for utilities, amounts due when tenants … specified in leases. During our audit scope, PANYNJ’s Real Estate Department leased seven external spaces for its …
https://www.osc.ny.gov/state-agencies/audits/2021/05/04/selected-aspects-leasing-practices-real-estate-department-aviation-world-trade-center-andDiNapoli: 33.55 Percent Annual Investment Return for New York State Pension Fund Is Largest in Its History
… been the state and local governments, which consistently pay their contributions in good times and bad. As of March … in cash, bonds, and mortgages (23.14 percent), private equity (10.57 percent), real estate and real assets (8.24 …
https://www.osc.ny.gov/press/releases/2021/05/dinapoli-33-point-55-percent-annual-investment-return-new-york-state-pension-fund-largest-its-historyInappropriate Premium Payments for Recipients No Longer Enrolled in Mainstream Managed Care and Family Health Plus (Follow-Up)
… for Recipients No Longer Enrolled in Mainstream Managed Care and Family Health Plus (Report 2015-S-47 ). About the … Medicaid recipients are enrolled into mainstream managed care, which provides comprehensive medical coverage. During … Family Health Plus (FHP) was a publicly funded managed care program for individuals whose income was too high to …
https://www.osc.ny.gov/state-agencies/audits/2020/02/25/inappropriate-premium-payments-recipients-no-longer-enrolled-mainstream-managed-care-and