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Center for Disability Services – Compliance With the Reimbursable Cost Manual
… Reimbursable Cost Manual (Manual). Our audit covered the calendar year ended December 31, 2013. Background CFDS is an … costs must comply with Manual requirements. For the calendar year ended December 31, 2013, CFDS reported about …
https://www.osc.ny.gov/state-agencies/audits/2016/05/13/center-disability-services-compliance-reimbursable-cost-manualUnnecessary Managed Care Payments for Medicaid Recipients With Medicare (Follow-Up)
… Purpose To determine the extent of implementation of the six … Department of Health (Department) made premium payments to Medicaid managed care plans for Medicaid recipients who … for the recipients in question, the net savings to Medicaid would have been about $36 million. The …
https://www.osc.ny.gov/state-agencies/audits/2013/11/01/unnecessary-managed-care-payments-medicaid-recipients-medicare-followAnnual Assessment of Market Orders for 2012, 2013, and 2014
… the Department, the Market Order Administration unit is responsible for administration of all farm product market … specific market order detailed in Department regulations is established to assist the industry in achieving a variety … Order Program, particularly its Apple Market Order, which is administered pursuant to a contract with the New York …
https://www.osc.ny.gov/state-agencies/audits/2015/05/07/annual-assessment-market-orders-2012-2013-and-2014Medicaid Program – Overpayments for Services Also Covered by Medicare Part B
… 1, 2009 through December 31, 2009. Background Medicare is a federal health program for the elderly and disabled. It … for medical care provided in outpatient settings. Medicaid is a joint state and federal health program for certain … "dual eligibles." For dual eligible recipients, Medicare is generally the primary payer while Medicaid is the …
https://www.osc.ny.gov/state-agencies/audits/2013/07/09/medicaid-program-overpayments-services-also-covered-medicare-part-bSexual Harassment Policy for the Office of the State Comptroller
… Introduction The Office of the State Comptroller (OSC) is committed to maintaining a workplace free from sexual harassment. Sexual harassment is a form of workplace sex discrimination. All employees are … prevents sexual harassment in the workplace. This Policy is one component of OSC’s commitment to a discrimination-free …
https://www.osc.ny.gov/sexual-harassment-policyMedicaid Program – Improper Managed Care Payments for Misclassified Patient Discharges
… to reimburse hospitals for inpatient medical care. When a hospital bills an MCO for an inpatient stay, the hospital reports certain information on its claims, such as … than if the patient was simply discharged home from the hospital. Key Findings The audit identified 2,808 managed …
https://www.osc.ny.gov/state-agencies/audits/2022/08/19/medicaid-program-improper-managed-care-payments-misclassified-patient-dischargesCompliance With Special Education Regulations for the Provision of Services
… in special education. In New York City (NYC), the DOE is responsible for determining eligibility for and providing … parental consent to evaluate. However, arranging placement is not the end of the process as it is more important that eligible students be provided with the …
https://www.osc.ny.gov/state-agencies/audits/2020/09/30/compliance-special-education-regulations-provision-servicesImproper Fee-for-Service Payments for Services Covered by Managed Care (Follow-Up)
… Objective To determine the extent of implementation of the six … system, pays providers directly for services rendered to Medicaid recipients. Under the managed care method, the … the managed care plans pay providers for services rendered to their members. The State’s Medicaid program offers …
https://www.osc.ny.gov/state-agencies/audits/2021/02/11/improper-fee-service-payments-services-covered-managed-care-followSelected Aspects of Collecting Outstanding Amounts Due for Parking Violations
… that can issue parking summonses within New York City (NYC). During fiscal years 2017 through 2019, DOF processed … for collecting fines and fees for violations issued within NYC, and also the Outside Collection Agency/External Inquiry … from respondents who have New York plates and live within NYC. DOF refers other cases to the NYC Law Department, which …
https://www.osc.ny.gov/state-agencies/audits/2021/03/23/selected-aspects-collecting-outstanding-amounts-due-parking-violationsImproper Medicaid Payments for Recipients Diagnosed With Severe Malnutrition (Follow-Up)
… Objective To determine the extent of implementation of the two … of Diseases (ICD) code on its Medicaid claim to reflect the diagnosis. Generally, as the severity of the malnutrition diagnosis increases, Medicaid’s payment to a hospital will increase. We issued our initial audit …
https://www.osc.ny.gov/state-agencies/audits/2020/09/02/improper-medicaid-payments-recipients-diagnosed-severe-malnutrition-followMedicaid Overpayments for Inpatient Care Involving Mechanical Ventilation Services (Follow-Up)
… 2018-S-45 ). About the Program Mechanical ventilation is the use of a device to inflate and deflate a patient’s … air to the lungs in a patient whose ability to breathe is diminished or lost. Hospitals use International … in the initial audit report; however, additional action is needed. In particular, the Office of the Medicaid …
https://www.osc.ny.gov/state-agencies/audits/2020/09/15/medicaid-overpayments-inpatient-care-involving-mechanical-ventilation-services-followEmblemHealth Plan, Inc.: Overpayments for Services Requiring Coordination of Benefits
… Program (Dental Program). Coordination of benefits (COB) is a process health insurance companies use for paying health care claims when an individual is covered by more than one insurance plan. This process … pays remaining expenses second (secondary payer). This is necessary to prevent duplicate payment of services by the …
https://www.osc.ny.gov/state-agencies/audits/2024/01/08/emblemhealth-plan-inc-overpayments-services-requiring-coordination-benefitsApplication Review and Site Permitting for Major Renewable Energy Projects
… Under the Climate Act, the Public Service Commission (PSC) was required to establish a renewable energy program by … secured by load-serving entities (entities subject to PSC jurisdiction that secure energy to serve the end-use … for planning purposes and to understand the feasibility of meeting Climate Act goals, all site permit process time …
https://www.osc.ny.gov/state-agencies/audits/2024/04/24/application-review-and-site-permitting-major-renewable-energy-projectsCantalician Center for Learning – Compliance With the Reimbursable Cost Manual
… determine whether the costs reported by Cantalician Center for Learning (Cantalician) on its Consolidated Fiscal Reports … submitted by Cantalician to SED on its 2016 and 2017 CFRs for the fiscal year ended June 30, 2017. About the Program Cantalician is an SED-approved, not-for-profit special education provider located in Depew, …
https://www.osc.ny.gov/state-agencies/audits/2023/01/26/cantalician-center-learning-compliance-reimbursable-cost-manualImproper Payments of Medicare Buy-in Premiums for Ineligible Recipients (Follow-Up)
… by the Centers for Medicare & Medicaid Services (CMS), Medicaid pays Medicare premiums for individuals who … and process enrollment in the Buy-in Program. In addition, CMS automatically enrolls certain individuals. Medicaid … who were automatically added to the Buy-in Program by CMS with coverage beginning more than 2 years retroactively, …
https://www.osc.ny.gov/state-agencies/audits/2023/04/12/improper-payments-medicare-buy-premiums-ineligible-recipients-followUse of Federal Funding for Election Technology and Security (Follow-Up)
… Objective To determine the extent of implementation of the one … administering and enforcing election laws in the State. To fulfill these responsibilities, the BOE offers assistance to the 57 County Boards of Elections and the New York City … To determine the extent of implementation of the one …
https://www.osc.ny.gov/state-agencies/audits/2023/06/22/use-federal-funding-election-technology-and-security-followBenefits Advisement Services for Individuals With Disabilities Seeking Employment (Follow-Up)
… Program According to the 2021 American Community Survey (ACS), there were approximately 1 million working-age adults … to about 75% for people without disabilities. Further, ACS data shows that New Yorkers with disabilities are more …
https://www.osc.ny.gov/state-agencies/audits/2023/06/22/benefits-advisement-services-individuals-disabilities-seeking-employment-followQueens Centers for Progress – Compliance With the Reimbursable Cost Manual
… Objective To determine whether the costs reported by Queens Centers for … (CFRs) were reasonable, necessary, directly related to the special education program, and sufficiently documented … To determine whether the costs reported by Queens Centers for …
https://www.osc.ny.gov/state-agencies/audits/2023/08/10/queens-centers-progress-compliance-reimbursable-cost-manualUnitedHealthcare Insurance Company of New York – Overpayments for Physician-Administered Drugs
… district employees, and their dependents. The Empire Plan is the primary health benefits plan for NYSHIP, serving about … Prescription Drug Program. A physician-administered drug is an outpatient drug (other than a vaccine) that is usually administered by a health care provider in a …
https://www.osc.ny.gov/state-agencies/audits/2023/09/13/unitedhealthcare-insurance-company-new-york-overpayments-physician-administered-drugsMedicaid Program – Improper Medicaid Payments for Recipients in Hospice Care
… medical social services, drugs for symptom control and pain relief, counseling, and physical and occupational …
https://www.osc.ny.gov/state-agencies/audits/2018/12/11/medicaid-program-improper-medicaid-payments-recipients-hospice-care