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New York State Health Insurance Program – Empire Plan Members With Dual Family Coverage (Follow-Up)
… two recommendations included in our initial audit report, New York State Health Insurance Program: Empire Plan Members … Family Coverage (Report 2019-S-23 ). About the Program The New York State Health Insurance Program (NYSHIP), …
https://www.osc.ny.gov/state-agencies/audits/2022/09/26/new-york-state-health-insurance-program-empire-plan-members-dual-family-coverage-followAccuracy of Medicaid Eligibility Determined by NY State of Health (Follow-Up)
… Objective To determine the extent of implementation of the six … ). About the Program NY State of Health (NYSOH) is the online health plan marketplace organized under the Department … and enrollment information is transmitted from NYSOH to the Department’s Medicaid claims processing and payment …
https://www.osc.ny.gov/state-agencies/audits/2022/09/30/accuracy-medicaid-eligibility-determined-ny-state-health-followImproper Medicaid Payments for Terminated Drugs (Follow-Up)
… in our initial audit report, Improper Medicaid Payments for Terminated Drugs (Report 2019-S-45 ). About the Program … and is overseen at the federal level by the Centers for Medicare & Medicaid Services (CMS). The Medicaid program … Drugs may be removed from the market (i.e., terminated) for safety or commercial reasons. To ensure terminated drugs …
https://www.osc.ny.gov/state-agencies/audits/2022/09/08/improper-medicaid-payments-terminated-drugs-followNew York State Dental Program – Payments for Scaling and Root Planing Procedures (Follow-Up)
… Purpose To determine the extent of implementation of the three recommendations included in our initial report … (GHI) established adequate controls over the payment of scaling and root planing procedures and whether GHI …
https://www.osc.ny.gov/state-agencies/audits/2013/11/12/new-york-state-dental-program-payments-scaling-and-root-planing-procedures-followCity of Yonkers – Budget Review (B22-6-6)
… which impact the City of Yonkers' financial condition in the current and future years. Background The Office of the … year 2022-23 and the related justification documents are in compliance with the requirements of the Fiscal Agent Act … of 10.3 percen t . Key Findings The 2022-23 budget relies on nonrecurring revenue of $142.7 million, such as fund …
https://www.osc.ny.gov/local-government/audits/city/2022/06/10/city-yonkers-budget-review-b22-6-6Empire BlueCross BlueShield – Selected Payments for Special Items for the Period April 1, 2011 Through June 30, 2011 (Follow-Up)
… extent of implementation of the three recommendations made in our audit report, Empire BlueCross BlueShield: Selected … Empire processes and pays claims for hospital services in accordance with agreements Empire negotiates with member … Payments for hospital services are generally based on standard fee schedules. However, hospitals may be entitled …
https://www.osc.ny.gov/state-agencies/audits/2014/10/30/empire-bluecross-blueshield-selected-payments-special-items-period-april-1-2011-throughBrighter Choice Charter Middle School for Boys – Financial Operations (2013M-348)
… Brighter Choice Charter Middle School for Boys is located in the City of Albany, and is governed by a Board of … into a three-year compact agreement with the Foundation in June 2011. All Board members voted in favor of the compact … revenue, does not appear to be reasonable, as the services being provided do not have any bearing on the number of …
https://www.osc.ny.gov/local-government/audits/school-district/2014/02/07/brighter-choice-charter-middle-school-boys-financial-operations-2013m-348CVS Health – Accuracy of Drug Rebate Revenue Remitted to the Department of Civil Service (Follow-Up)
… of implementation of the two recommendations included in our initial audit report, Accuracy of Drug Rebate Revenue … the period from January 1, 2014 through December 31, 2018. In accordance with the contract, CVS Health was required to … revenue to Civil Service. Our initial audit report, issued on August 21, 2020, sought to determine if CVS Health …
https://www.osc.ny.gov/state-agencies/audits/2021/11/16/cvs-health-accuracy-drug-rebate-revenue-remitted-department-civil-service-followImproper Fee-for-Service Payments for Services Covered by Managed Long-Term Care Plans (Follow-Up)
… Objective To determine the extent of implementation of the three recommendations included in our initial audit … in their homes and communities. MLTC plans offer a range of services, such as home health care, nursing home care, …
https://www.osc.ny.gov/state-agencies/audits/2021/08/31/improper-fee-service-payments-services-covered-managed-long-term-care-plans-followSelected Aspects of Parking Violations Operations to Collect Fines and Fees
… Objective To determine whether the New York City Department of Finance (DOF) identifies and collects fines and fees that … processed about 20 million summonses with a total value of $901 million and $994 million, respectively. DOF’s role includes generating and mailing notices of violations, collecting the amounts due, and adjudicating …
https://www.osc.ny.gov/state-agencies/audits/2019/12/04/selected-aspects-parking-violations-operations-collect-fines-and-feesMedicaid Program – Cost of Pharmacy Services Under Managed Care
… under managed care. Rather, the Department has relied on MCOs and the MCOs’ Pharmacy Benefit Managers to achieve … efficiently managing drug costs for the Medicaid program. Key Findings The Department missed opportunities to minimize … result in the use of the most cost-effective drugs. Key Recommendation Conduct timely routine analyses to …
https://www.osc.ny.gov/state-agencies/audits/2020/09/17/medicaid-program-cost-pharmacy-services-under-managed-careMedicaid Program – Accuracy of Medicaid Eligibility Determined by NY State of Health
… (MCOs) a monthly premium for each enrolled recipient and, in turn, the MCOs pay health care providers for services … families, and small businesses can search for and enroll in Medicaid and other health insurance plans. An individual’s … the Department’s eMedNY system. The eMedNY system relies on the information sent by NYSOH to update eligibility and …
https://www.osc.ny.gov/state-agencies/audits/2020/09/17/medicaid-program-accuracy-medicaid-eligibility-determined-ny-state-healthSelected Employee Travel Expenses
… employees was appropriate, we audited a total of $588,029 in travel expenses for 17 Department of Health (Department) … to inadequate Department oversight. Of the $121,727 in travel expenses we examined for the three employees, we … Specifically, the Department overpaid $3,939 due to errors in applying travel rules and other wasteful spending, and …
https://www.osc.ny.gov/state-agencies/audits/2014/05/22/selected-employee-travel-expensesAffordable Home Ownership Development Program
… grant monies to existing and prospective homeowners in compliance with Program criteria. Our audit covers the period February 2012 through October 2013, and focuses on grants awarded to eight metropolitan area-based … assets of recipients must be below the limits stipulated in the contracts between the Corporation and the various …
https://www.osc.ny.gov/state-agencies/audits/2014/10/06/affordable-home-ownership-development-programOverpayments of Certain Medicare Crossover Claims
… directly to Medicaid and bypassed the controls afforded by the crossover system. Key Recommendations Correct the … the Medicaid overpayments totaling $10 million caused by flawed eMedNY computer programs that incorrectly processed … of Health: Overpayments for Services Also Covered by Medicare Part B (2010-S-50) Department of Health: …
https://www.osc.ny.gov/state-agencies/audits/2013/01/10/overpayments-certain-medicare-crossover-claimsWyoming County Court and Trust Funds (2020-C&T-2)
… Finance Law, the Treasurer is required to submit a report on an annual basis to the State Comptroller accounting for … deposited to the court and ordered into her custody. In addition, pursuant to New York State Abandoned Property Law, money that has remained in the hands of the Treasurer for a period of three years, …
https://www.osc.ny.gov/local-government/audits/court-and-trust/2020/05/08/wyoming-county-court-and-trust-funds-2020-ct-2St. Lawrence-Lewis Board of Cooperative Educational Services – Capital Assets (2023M-99)
… Objective Determine whether the St. Lawrence-Lewis Board of Cooperative Educational Services (BOCES) officials … was erased before assets with hard drives were disposed of. Sixty-nine out of 140 recorded IT assets could not be located. These assets …
https://www.osc.ny.gov/local-government/audits/boces/2023/12/01/st-lawrence-lewis-board-cooperative-educational-services-capital-assets-2023m-99Medicaid Program – Medicaid Payments to Medicare Advantage Plan Providers
… Background Many Medicaid recipients are also enrolled in Medicare. Such recipients are commonly referred to as “dual-eligibles.” In 1997, Congress established Medicare Part C, the Medicare … plan contracts offered by Fidelis and WellCare and, based on judgmental sampling, determined certain providers reported …
https://www.osc.ny.gov/state-agencies/audits/2018/09/10/medicaid-program-medicaid-payments-medicare-advantage-plan-providersRockland County – Budget Review (B6-13-22)
… the significant revenue and expenditure projections in the County’s proposed budget for the 2014 fiscal year are … totaling $96,000,000 to liquidate the cumulative deficit in the County’s general fund for the fiscal year ending … deficit obligations are outstanding. Key Findings Based on the results of our review, except for the matters …
https://www.osc.ny.gov/local-government/audits/county/2013/11/25/rockland-county-budget-review-b6-13-22Allegany County – County Jail Payroll and Inmate Prescription Medications (2013M-218)
… to June 5, 2013. Background Allegany County is located in the Southern Tier of Western New York and has a population … Key Findings The County paid approximately $4.4 million in wages for correctional staff during the 2012 calendar … that the County could have purchased the same medications on State bid and realized savings of more than $32,000 …
https://www.osc.ny.gov/local-government/audits/county/2014/01/24/allegany-county-county-jail-payroll-and-inmate-prescription-medications-2013m-218