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UnitedHealthcare – Overpayments for Out-of-Network Anesthesia Services Provided at In-Network Ambulatory Surgery Centers

… Purpose To determine whether UnitedHealthcare overpaid for … Surgery Centers that were contractually required to use in-network anesthesia providers. The audit covered the …

Sheriffs, Undersheriffs and Deputy Sheriffs Special Plan for ERS Tier 3, 4, 5 and 6 Members – Sheriffs, Undersheriffs and Deputy Sheriffs Special Plan for ERS Tier 3, 4, 5 and 6 Members

Sheriffs, Undersheriffs and Deputy Sheriffs Special Plan for ERS Tier 1 and 2 Members – Sheriffs, Undersheriffs and Deputy Sheriffs Special Plan for ERS Tier 1 and 2 Members

Medicaid Program – Managed Care Premium Payments for Recipients With Comprehensive Third-Party Insurance

… Purpose To determine whether the Department of Health (Department) made Medicaid mainstream managed care premium payments on behalf of individuals who had … As of August 2017, 4.4 million people were enrolled in mainstream managed care plans – about 2.5 million were …

UnitedHealthcare – Improper Payments for Medical Services Designated By Modifier Code 59 (Follow-Up)

… to medical providers are based, in part, on procedure codes billed on claims that indicate the medical services … assessment to identify providers with unusual modifier 59 billing patterns and take appropriate actions, including … new fraud and abuse detection program to identify aberrant billing patterns, including inappropriate uses of modifier …

Special 25-Year Plan for Institutional Safety Officers (Sections 89-t and 604(q))

… and Local Retirement System  (Return to Top) … Information for members about special 25 year retirement plan providing an alternative retirement benefit for institutional safety officers and safety and secur …

United HealthCare – Overpayments for Services Provided by Eastern Orange Ambulatory Surgery Center

… LLC waived Empire Plan members’ out-of-pocket costs, and if so, to quantify the overpayments made by United HealthCare resulting from … it will result in United making an excessive payment on the claim. Our audit focused on claims submitted to United …

Medicaid Program – Improper Payments for Controlled Substances That Exceed Allowed Dispensing Limits

… whether the Department of Health paid pharmacy providers for controlled substances in compliance with the New York … risk of drugs ordered in this manner being diverted for inappropriate or unauthorized use. The supply limits that … Medicaid program paid pharmacy providers through the fee-for-service method and the managed care method. Under …

Special Plan for Suffolk County Park Police Officers (Sections 89-r and 603(n))

… (Return to Top) (Return to Top) VO1855 (Rev. 6/12) © 2012, New York State and Local Retirement System (Return to Top) … …

DiNapoli: State Pays Drug Treatment Center Nearly $4 Million for Ineligible Expenses

… treatment provider was able to collect $3.9 million in ineligible payments due to the processing of invalid … $47.6 million contract with Phoenix House New York (PHNY) in 2009 to provide outpatient, inpatient, and residential … alcohol addiction treatment services at several facilities in the New York metropolitan area. The state’s contract with …

DiNapoli Audit Highlights Need for Better Compliance with School Violence Reporting Law

… (SED) has agreed to improve its enforcement of the Safe Schools Against Violence in Education Act (SAVE Act) after a state audit found schools … extent to which the seventh school, Burgard Vocational High School in Buffalo, underreported because it used an …

Medicaid Program – Medicaid Payments for Pharmacy Claims: Joia Pharmacy and a Related Prescriber

… and locally funded program that provides a wide range of medical services to those who are economically disadvantaged … the appropriateness of the providers’ (pharmacists and physicians) future participation in the Medicaid program. …

Medicaid Program – Reducing Medicaid Costs for Recipients With End Stage Renal Disease

… Purpose To determine whether the Department of Health took sufficient steps to control the Medicaid costs of recipients diagnosed with end stage … who were eligible for, but not enrolled in, Medicare. The audit covered the period January 1, 2010 through December …

Oversight of Hotels and Motels Used for Homeless and Mixed-Use Temporary Residency

… (15 percent) are located in areas outside of New York City (NYC). Counties throughout the State utilize hotels and motels … of hotels and motels housing the homeless to local Social Services Districts (SSDs) and to the NYC Department of …

Lifeline Center for Child Development, Inc. – Compliance With the Reimbursable Cost Manual

… the ages of three and five years. During the 2014-15 school year, Lifeline served about 52 students. The New York … space and staff with a DoE District 75 program that serves school-age special education students. Key Findings For the …

Brookville Center for Children’s Services, Inc. – Compliance With the Reimbursable Cost Manual

… the ages of three and five years. During the 2013-14 school year, Brookville served about 456 students. Local …

Payments for Fraudulent and Improper Claims Submitted by Davis Ethical Pharmacy (Follow-Up)

… included in our initial audit report, Payments for Fraudulent and Improper Claims Submitted by Davis Ethical … which was issued on August 13, 2013, determined that, for the period January 1, 2008 through December 13, 2011, … fraudulent claims to Medicaid and received payments for those claims. We coordinated our audit and investigative …

DiNapoli Statement on Greenville Arrest for Alleged Theft of Taxpayer Funded Resources

… and paid for by taxpayers," DiNapoli said. "Thanks to my ongoing partnership with the New York State Police, Mr. …

DiNapoli Announces Interim CIO for the New York State Common Retirement Fund

… retiring the week of July 30 after six years of service. "My thanks go to Vicki Fuller, during whose tenure the Fund … public employees, retirees and their beneficiaries." "My gratitude goes to Comptroller DiNapoli for his trust and …

Medicaid Program – Improper Fee-for-Service Payments for Pharmacy Services Covered by Managed Care

… disadvantaged and/or have special health care needs. In general, the Medicaid program pays medical providers … a monthly premium for every Medicaid recipient enrolled in the MCO, and the MCO arranges for the provision of … was no longer appropriate for recipients enrolled in managed care. As of December 2013, approximately 4 million …