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Unnecessary Medicaid Payments for Children at Voluntary Agencies (Follow-Up)
… extent of implementation of the five recommendations made in our audit report, Unnecessary Medicaid Payments for … Health (Department) had adequate policies and procedures in place to ensure proper Medicaid payments for foster care children placed in voluntary agencies. The Department administers the New …
https://www.osc.ny.gov/state-agencies/audits/2014/10/23/unnecessary-medicaid-payments-children-voluntary-agencies-followImproper Managed Care Payments for Certain Medicaid Recipients (Follow-Up)
… five recommendations made in our audit report, Improper Managed Care Payments for Certain Medicaid Recipients (Report … June 30, 2010, Medicaid made $15.6 million in improper managed care payments on behalf of 14,899 recipients who, by State law, were precluded from enrollment in managed care programs. We recommended that the Department …
https://www.osc.ny.gov/state-agencies/audits/2015/01/20/improper-managed-care-payments-certain-medicaid-recipients-followStatus of the Board-Approved Capital Plan for 2005-2011 (Follow-Up)
… our initial report, Status of the Board-Approved Capital Plan for 2005-2011 (Report 2008-S-48). Background Our initial … status of the project items in the Board-Approved Capital Plan for 2005-2011. We also examined whether the project items on the capital plan were starting and finishing on time and remaining within …
https://www.osc.ny.gov/state-agencies/audits/2013/06/27/status-board-approved-capital-plan-2005-2011-followEmpire BlueCross BlueShield – Controls Over Payments for Special Items
… Purpose To determine if Empire BlueCross BlueShield: implemented sufficient controls … and school district employees, and their dependents. The Empire Plan is the primary health benefits plan for NYSHIP, serving about 1.1 million members. The Empire Plan covers a comprehensive range of services …
https://www.osc.ny.gov/state-agencies/audits/2017/06/22/empire-bluecross-blueshield-controls-over-payments-special-itemsManagement of Indoor Air Quality for Individuals With Asthma
… the Program Asthma is a significant public health problem in the United States. It is one of this country’s most common … to the Centers for Disease Control and Prevention (CDC), in 2018, asthma accounted for 178,530 hospitalizations and over 1.6 million emergency department visits in the United States. In 2019, asthma accounted for 3,524 …
https://www.osc.ny.gov/state-agencies/audits/2022/08/02/management-indoor-air-quality-individuals-asthmaImproper Medicaid Payments for Recipients in Hospice Care (Follow-Up)
… extent of implementation of the 11 recommendations made in our initial audit report, Improper Medicaid Payments for Recipients in Hospice Care ( 2017-S-76 ). About the Program Hospice is a … However, if a Medicaid recipient is also enrolled in Medicare, Medicare is the primary payer and Medicaid is …
https://www.osc.ny.gov/state-agencies/audits/2020/10/15/improper-medicaid-payments-recipients-hospice-care-followMedicaid Program – Improper Medicaid Payments for Misclassified Patient Discharges
… a patient was transferred to another facility may result in a lower payment than if a patient was simply discharged … status codes. Key Recommendations Review the $252,107 in overpayments and recover as appropriate. Review the … 2,017 high-risk claims totaling $28 million identified in this audit and recover overpayments as appropriate. Ensure …
https://www.osc.ny.gov/state-agencies/audits/2021/08/17/medicaid-program-improper-medicaid-payments-misclassified-patient-dischargesBenefits Advisement Services for Individuals With Disabilities Seeking Employment
… how work would impact their benefits, and developing a life coaching network available to all individuals with … an interactive benefits advisement calculator, automated life coaching communications, and information regarding … in the Report. Develop a network of professional life coaches who are educated in public benefits and work …
https://www.osc.ny.gov/state-agencies/audits/2021/07/20/benefits-advisement-services-individuals-disabilities-seeking-employmentUse of Federal Funding for Election Technology and Security
… responsible for administering and enforcing election laws in the State. To fulfill these responsibilities, the BOE … the U.S. Election Assistance Commission (EAC) to aid in the administration of federal elections. The EAC provides … these standards and secure and improve election systems. In 2018, the EAC made the HAVA Election Security Grant (HAVA …
https://www.osc.ny.gov/state-agencies/audits/2021/09/17/use-federal-funding-election-technology-and-securityUnitedHealthcare – Reasonable and Customary Reimbursement Rates for Delayed Claims
… benefits portion of the Empire Plan. United contracts with in-network providers to deliver services to Empire Plan … that were paid using an R&C rate period that was not in effect on the date of the service. Key Recommendations … based on their date of service (thereby using the R&C rate in effect on the date of the service). Review the claims …
https://www.osc.ny.gov/state-agencies/audits/2019/12/12/unitedhealthcare-reasonable-and-customary-reimbursement-rates-delayed-claimsMaximizing Drug Rebates for Health and Recovery Plans (Follow-Up)
… extent of implementation of the two recommendations made in our initial audit report, Maximizing Drug Rebates for … Recovery Plans (Report 2017-S-61 ). About the Program In 1990, Congress created the Medicaid Drug Rebate Program, … from drug manufacturers. The Affordable Care Act, enacted in 2010, extended prescription drug rebates to cover …
https://www.osc.ny.gov/state-agencies/audits/2020/01/17/maximizing-drug-rebates-health-and-recovery-plans-followEmpire BlueCross – Controls Over Payments for Special Items (Follow-Up)
… minimize the State’s risk of excessive payments resulting from contracts with hospitals that did not include language …
https://www.osc.ny.gov/state-agencies/audits/2020/02/25/empire-bluecross-controls-over-payments-special-items-followMedicaid Program – Excessive Payments for Durable Medical Equipment Rentals
… (MCOs) a monthly premium for each enrolled recipient and, in turn, the MCOs arrange for the provision of health care … repeated use and have been ordered by a practitioner in the treatment of a specific medical condition. Certain DME …
https://www.osc.ny.gov/state-agencies/audits/2023/04/12/medicaid-program-excessive-payments-durable-medical-equipment-rentalsImproper Managed Care Payments for Misclassified Patient Discharges (Follow-Up)
… for Medicaid recipients who were reported as discharged from a hospital but then admitted to a different hospital … a judgmental sample of 166 claims, totaling $2,474,162, from six hospitals, and reviewed the associated patients’ …
https://www.osc.ny.gov/state-agencies/audits/2023/12/06/improper-managed-care-payments-misclassified-patient-discharges-followAnnual Assessment of Market Orders for 2015 and 2016
… and Markets (Department) had adequate procedures in place during the audit period to accurately report its … dairy products. Each specific market order is established in Department regulations to assist the industry in achieving a variety of objectives, including product …
https://www.osc.ny.gov/state-agencies/audits/2019/05/16/annual-assessment-market-orders-2015-and-2016Medicaid Overpayments for Inpatient Care Involving Mechanical Ventilation Services
… provides the force needed to deliver air to the lungs in a patient whose ability to breathe is diminished or lost. … ventilation services. Key Finding We identified $975,795 in overpayments on 32 inpatient claims that reported 96 …
https://www.osc.ny.gov/state-agencies/audits/2019/05/16/medicaid-overpayments-inpatient-care-involving-mechanical-ventilation-servicesMedicaid Program – Medicaid Overpayments for Medicare Advantage Plan Services
… Purpose To determine if the Department of Health overpaid health care providers’ Medicaid claims for services also … To determine if the Department of Health overpaid health care providers Medicaid claims for …
https://www.osc.ny.gov/state-agencies/audits/2018/12/11/medicaid-program-medicaid-overpayments-medicare-advantage-plan-servicesRestrictions on Consecutive Hours of Work for Nurses (Follow-Up)
… of implementation of the five recommendations included in our initial audit report Restrictions on Consecutive Hours … Nurses (RNs) and Licensed Practical Nurses (LPNs) in non-emergency situations. The Law applies to RNs and LPNs who provide direct patient care in hospitals, nursing homes, treatment centers, and other …
https://www.osc.ny.gov/state-agencies/audits/2019/09/09/restrictions-consecutive-hours-work-nurses-followImplementation of the Dignity for All Students Act (Follow-Up)
… initial audit report, Implementation of the Dignity for All Students Act (Report 2016-S-28 ). About the Program New York State’s Dignity for All Students Act (DASA) seeks to provide students in New York … report some DASA incidents or may not report them at all, and incident records often were not adequate to clearly …
https://www.osc.ny.gov/state-agencies/audits/2019/11/21/implementation-dignity-all-students-act-followMedicaid Program – Improper Payments for Certain Third-Party Cost-Sharing Claims
… a PR 45 cost-sharing amount. The audit covered the period from December 2020 through May 2024. About the Program The … sources of health care coverage, such as Medicare and group health plans (third-party insurers). Medicaid is … resort and, as such, providers are required to coordinate benefits with third-party insurers prior to billing Medicaid …
https://www.osc.ny.gov/state-agencies/audits/2025/11/05/medicaid-program-improper-payments-certain-third-party-cost-sharing-claims