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Medicaid Program – Managed Care Organizations: Payments to Ineligible Providers

… whether the Department of Health (Department) and managed care organizations (MCOs) have adequate processes in … Medicaid claim costs totaled over $58 billion, of which managed care accounted for about $34 billion. Under managed care, Medicaid pays MCOs a monthly premium for each …

https://www.osc.ny.gov/state-agencies/audits/2018/02/26/medicaid-program-managed-care-organizations-payments-ineligible-providers

Purchasing Practices at the Linden Plaza Mitchell-Lama Housing Development

… Housing Program, created in 1955, provides affordable rental and cooperative housing to moderate- and middle-income … New York City, there are 94 HPD-supervised Mitchell-Lama rental and limited-equity cooperative developments with … $4.6 million in non-contract payments to 163 vendors. The Rules of the City of New York (Rules) require that contracts …

https://www.osc.ny.gov/state-agencies/audits/2018/09/06/purchasing-practices-linden-plaza-mitchell-lama-housing-development

Selected Management and Operations Practices (Follow-Up)

… of New York signed into law the ReCharge New York (RNY) power program as part of Chapter 60 (part CC) of the Laws of 2011 (Law). RNY power is to be allocated to businesses and not-for-profits … by 29,795, or 7.7 percent. NYPA sold scrap metal and plant equipment without appropriate controls and …

https://www.osc.ny.gov/state-agencies/audits/2018/12/11/selected-management-and-operations-practices-follow

Train On-Time Performance (Follow-up)

… Purpose To determine the extent of implementation of the two … percent. In late March 2015, Subways OTP goal was lowered to 75.0 percent. Subways lacked a formal process to assess the underlying causes of the delays and develop … To determine the extent of implementation of the two …

https://www.osc.ny.gov/state-agencies/audits/2017/09/27/train-time-performance-follow

Subway Wait Assessment (Follow-Up)

… Transit had not developed a full and comprehensive plan to deal with the long-term causes of service disruptions, …

https://www.osc.ny.gov/state-agencies/audits/2017/10/06/subway-wait-assessment-follow

Assessment and Collection of Selected Penalties

… to notify WCB in writing when the claimant's insurance carrier fails to pay or notify them within 45 days that … it is determined that payment should have been made by the carrier, the law requires WCB to impose a $50 penalty (HP-1 … Workers' Compensation Board: Workers' Compensation Program: Statement of Assessable Expenses for the Three …

https://www.osc.ny.gov/state-agencies/audits/2013/09/24/assessment-and-collection-selected-penalties

Medicaid Program – Overpayments of Ambulatory Patient Group Claims

… For example, Medicaid paid a provider $149 for a clinic visit that was billed under one particular rate code. … Department of Health: Medicaid Payments for Excessive Dental Services (2009-S-46) …

https://www.osc.ny.gov/state-agencies/audits/2013/08/20/medicaid-program-overpayments-ambulatory-patient-group-claims

Medicaid Program - Medicaid Overpayments for Certain Medicare Part C Claims

… “dual-eligibles.” In 1997, Congress established Medicare Part C, the Medicare managed care program also known as Medicare Advantage. Under Medicare Part C, private managed care companies administer Medicare … plan providers bill Medicaid directly for the enrollee’s Part C cost-sharing liabilities (deductibles, coinsurance, …

https://www.osc.ny.gov/state-agencies/audits/2015/01/16/medicaid-program-medicaid-overpayments-certain-medicare-part-c-claims

Selected Financial Management and Administrative Practices

… period. Each Public Administrator maintains a suspense account to pay estate-related expenses not covered by the … of employees who are paid through the suspense account, as otherwise required by governing regulations and … The average monthly balance in the NCPA’s suspense account dropped from $241,214 in 2010, to $74,442 in 2013 ‒ a …

https://www.osc.ny.gov/state-agencies/audits/2015/04/28/selected-financial-management-and-administrative-practices

Medicaid Overpayments for Non-Emergency Out-of-State Inpatient Services (Follow-Up)

… of implementation of the four recommendations included in our initial audit report, Medicaid Overpayments for … payment.  Auditors further identified $10.8 million in claim payments for which the Department had not granted … services. Key Finding Department officials made progress in addressing the issues we identified in the initial audit.  …

https://www.osc.ny.gov/state-agencies/audits/2013/03/11/medicaid-overpayments-non-emergency-out-state-inpatient-services-follow

Medicaid Overpayments for Out-of-State Ambulatory Surgery Services (Follow-Up)

… of implementation of the two recommendations included in our initial audit report, Medicaid Overpayments for … through June 30, 2009, auditors identified $12.2 million in actual and potential Medicaid overpayments to out-of-state … of September 30, 2012, of the two recommendations included in our initial report. Key Finding Department and Office of …

https://www.osc.ny.gov/state-agencies/audits/2013/01/10/medicaid-overpayments-out-state-ambulatory-surgery-services-follow

Bus Driver Licensing (Follow-Up)

… four recommendations included in our initial report, Bus Driver Licensing (2012-S-30). Background Our initial report, … four recommendations included in our initial report Bus Driver Licensing 2012S30 …

https://www.osc.ny.gov/state-agencies/audits/2016/01/21/bus-driver-licensing-follow

Forensic Audit of Select Payroll and Overtime Practices and Related Transactions (Follow-Up)

… related to Hours of Service that may have been avoidable. For calendar 2010, we determined that these practices cost … these payments will inflate future pension payments for these employees by about $5.5 million. We also found …

https://www.osc.ny.gov/state-agencies/audits/2016/03/18/forensic-audit-select-payroll-and-overtime-practices-and-related-transactions-follow

Empire BlueCross BlueShield – Selected Payments for Special Items for the Period January 1, 2012 Through June 30, 2012 (Follow-Up)

… of implementation of the three recommendations made in our audit report, New York State Health Insurance Program: Empire BlueCross BlueShield Selected … million for 38,381 claims for special items. Our initial audit report, which was issued on December 13, 2013, found …

https://www.osc.ny.gov/state-agencies/audits/2015/12/28/empire-bluecross-blueshield-selected-payments-special-items-period-january-1-2012-through

Suspicious and Fraudulent Medicaid Payments to Affiliated Brooklyn Dentists (Follow-Up)

… special health care needs. Our initial audit identified a dentist, Lawrence Bruckner, whose Medicaid billing pattern … that were purportedly provided by another affiliated dentist. In addition, the dentists paid staff to recruit …

https://www.osc.ny.gov/state-agencies/audits/2015/12/30/suspicious-and-fraudulent-medicaid-payments-affiliated-brooklyn-dentists-follow

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

… Background Our initial audit report, which was issued on August 13, 2013, determined that, for the period January 1, …

https://www.osc.ny.gov/state-agencies/audits/2016/02/18/united-healthcare-payments-fraudulent-and-improper-claims-submitted-davis-ethical-pharmacy

Access-A-Ride Accident Claims (Follow-Up)

… ( 2012-S-12 ). Background Our initial report, issued on April 24, 2014, determined that between 2008 and 2012 the … traditional carriers decreased and reliance on the black car services and taxis increased. The number of reported accidents also initially increased, but decreased between …

https://www.osc.ny.gov/state-agencies/audits/2016/05/13/access-ride-accident-claims-follow

Benefit Eligibility Assessment Process (Follow-Up)

… Background Our initial audit, which was issued on May 28, 2014, determined whether the New York City Human … the Office of Temporary and Disability Assistance’s (OTDA) Fair Hearing process was used only as necessary. The audit … through September 30, 2013. We found that HRA applied a fair and consistent assessment process when determining …

https://www.osc.ny.gov/state-agencies/audits/2016/06/16/benefit-eligibility-assessment-process-follow

Compliance With Payment Card Industry Standards

… of New York (SUNY) schools are in compliance with Payment Card Industry (PCI) standards and whether SUNY System … All industries that accept credit cards as a method of payment must comply with the Data Security Standards (DSS) … data. SUNY schools accept credit cards as a method of payment (e.g., for tuition, housing, and meals), and as such …

https://www.osc.ny.gov/state-agencies/audits/2016/06/08/compliance-payment-card-industry-standards

Administration of Tenant Complaints

… New York State Homes and Community Renewal’s Office of Rent Administration addresses tenant complaints in a … New York State Homes and Community Renewal consists of all the State’s housing and community renewal agencies. These agencies include the Division of Housing and Community Renewal (Division), which is …

https://www.osc.ny.gov/state-agencies/audits/2014/12/11/administration-tenant-complaints