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Administration of the CityFHEPS Program for Department of Social Services Homebase Clients
… Objective To determine whether the New York City Department of Social Services (DSS) is administering the City Fighting Homelessness and Eviction Prevention Supplement (CityFHEPS) program according to the rules and regulations, thereby assisting residents in the …
https://www.osc.ny.gov/state-agencies/audits/2026/01/07/administration-cityfheps-program-department-social-services-homebase-clientsMedicaid Program – Medicaid Payments for Early Refills of Prescription Drugs and Supplies
… whether Medicaid made improper payments on pharmacy claims for early refills of prescription drugs and supplies. The … program. Through NYRx, DOH pays pharmacies directly for medically necessary prescription drugs and supplies … DOH uses system controls known as edits to deny claims for early refills that violate DOH policy. Key Findings For …
https://www.osc.ny.gov/state-agencies/audits/2026/03/20/medicaid-program-medicaid-payments-early-refills-prescription-drugs-and-suppliesUnitedHealthcare – Improper Payments for Medical Services Designated By Modifier Code 59 (Follow-Up)
… contracts with UnitedHealthcare (United) to process and pay medical and surgical claims for services provided to …
https://www.osc.ny.gov/state-agencies/audits/2017/12/27/unitedhealthcare-improper-payments-medical-services-designated-modifier-code-59-followMedicaid 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 comprehensive third-party health insurance coverage. The audit covered the period … To determine whether the Department of Health made Medicaid mainstream managed care premium payments …
https://www.osc.ny.gov/state-agencies/audits/2018/06/13/medicaid-program-managed-care-premium-payments-recipients-comprehensive-third-partyUnitedHealthcare – Overpayments for Out-of-Network Anesthesia Services Provided at In-Network Ambulatory Surgery Centers
… through December 31, 2016. Background The New York State Health Insurance Program (NYSHIP), administered by the State … office visits, diagnostic testing, outpatient surgery, physical therapy, and home care services. United processes and pays …
https://www.osc.ny.gov/state-agencies/audits/2018/08/13/unitedhealthcare-overpayments-out-network-anesthesia-services-provided-network-ambulatorySchool for Language and Communication Development – Compliance With the Reimbursable Cost Manual
… To determine whether the costs reported by the School for Language and Communication Development (SLCD) on its … To determine whether the costs reported by the School for Language and Communication Development on its Consolidated …
https://www.osc.ny.gov/state-agencies/audits/2018/04/16/school-language-and-communication-development-compliance-reimbursable-cost-manualBrookville Center for Children’s Services, Inc. – Compliance With the Reimbursable Cost Manual
… the costs were unnecessary and duplicative; $240,673 in lease expenses that were not in compliance with the Manual, … Other Related Audits/Reports of Interest Yeled v’Yalda Early Childhood Center: Compliance With the Reimbursable Cost Manual ( 2015-S-19 ) New York League for Early Learning, Inc.: Compliance With the Reimbursable Cost …
https://www.osc.ny.gov/state-agencies/audits/2017/10/04/brookville-center-childrens-services-inc-compliance-reimbursable-cost-manualLifeline Center for Child Development, Inc. – Compliance With the Reimbursable Cost Manual
… To determine whether the costs reported by Lifeline Center for Child Development, Inc. (Lifeline) on its Consolidated … focused primarily on expenses claimed on Lifeline’s CFR for the fiscal year ended June 30, 2015, and included certain expenses claimed on Lifeline’s CFRs for the two fiscal years ended June 30, 2014. Background …
https://www.osc.ny.gov/state-agencies/audits/2017/10/12/lifeline-center-child-development-inc-compliance-reimbursable-cost-manualMedicaid Program – Improper Payments for Controlled Substances That Exceed Allowed Dispensing Limits
… being diverted for inappropriate or unauthorized use. The supply limits that the Act imposes vary depending on the … that are highly prone to abuse are limited to a five-day supply, and others that carry less risk are limited to a 30-day supply. During the audit period, the Medicaid program paid …
https://www.osc.ny.gov/state-agencies/audits/2015/02/06/medicaid-program-improper-payments-controlled-substances-exceed-allowed-dispensing-limitsMedicaid Program – Improper Fee-for-Service Payments for Pharmacy Services Covered by Managed Care
… Medicaid made improper fee-for-service claim payments for pharmacy services covered by recipients’ managed care plans. … provided to their enrollees. Prior to October 2011, pharmacy benefits were reimbursed through the fee-for-service … care coverage. However, beginning October 1, 2011, most pharmacy benefits were covered by managed care plans, and …
https://www.osc.ny.gov/state-agencies/audits/2015/01/05/medicaid-program-improper-fee-service-payments-pharmacy-services-covered-managed-careEducators for Children, Youth and Families, Inc. – Use of Contract Funds (Follow-Up)
… of implementation of the three recommendations included in our initial audit report, Educators for Children, Youth … claims amounting to $1.8 million, out of $3.2 million in contract payments, to determine if the claims were … fraudulent transactions to an inactive Board of Directors. In addition, we found no evidence that there were any …
https://www.osc.ny.gov/state-agencies/audits/2013/08/13/educators-children-youth-and-families-inc-use-contract-funds-followMedicaid Program – Improper Payments for Ancillary Services Provided During Hospital Inpatient Admissions
… the costs of most medical care provided during a hospital admission. As such, claims for ancillary services provided during a hospital admission are generally not reimbursable. In 2007, the …
https://www.osc.ny.gov/state-agencies/audits/2014/04/03/medicaid-program-improper-payments-ancillary-services-provided-during-hospital-inpatientMedicaid Program – Medicaid Payments for Pharmacy Claims: Joia Pharmacy and a Related Prescriber
… To determine whether Medicaid made proper payments to Joia Pharmacy, Inc. (Joia) and a related prescriber (herein … During the audit period, Joia, doing business as Soho Pharmacy, was a privately owned pharmacy located in Lower Manhattan. Soho Pharmacy was still …
https://www.osc.ny.gov/state-agencies/audits/2017/06/27/medicaid-program-medicaid-payments-pharmacy-claims-joia-pharmacy-and-related-prescriberMedicaid Program – Reducing Medicaid Costs for Recipients With End Stage Renal Disease
… recipients with ESRD are eligible for Medicare coverage if they receive regular dialysis treatments or a kidney … and meet one of the following requirements: (1) have worked the required amount of time under Social … Medicaid recipients with ESRD and helped guide them on how to apply for and enroll in Medicare. In response to our …
https://www.osc.ny.gov/state-agencies/audits/2017/03/01/medicaid-program-reducing-medicaid-costs-recipients-end-stage-renal-diseaseSt. Mary’s Hospital for Children, Inc. – Compliance With the Reimbursable Cost Manual
… whether the costs reported by St. Mary’s Hospital for Children, Inc. (St. Mary’s) on its Consolidated Fiscal … ended December 31, 2018. About the Program St. Mary’s is a not-for-profit organization authorized by SED to provide full-day … determine whether the costs reported by St Marys Hospital for Children Inc on its Consolidated Fiscal Reports CFRs were …
https://www.osc.ny.gov/state-agencies/audits/2022/11/09/st-marys-hospital-children-inc-compliance-reimbursable-cost-manualImproper Fee-for-Service Payments for Services Covered by Managed Long-Term Care Plans (Follow-Up)
… Medicaid program offers managed long-term care (MLTC) coverage to people who are chronically ill or disabled and … wish to stay in their homes and communities. MLTC plans offer a range of services, such as home health care, nursing …
https://www.osc.ny.gov/state-agencies/audits/2021/08/31/improper-fee-service-payments-services-covered-managed-long-term-care-plans-followQuality Services for the Autism Community – Compliance With the Reimbursable Cost Manual
… determine whether the costs reported by Quality Services for the Autism Community (QSAC) on its Consolidated Fiscal … (RCM). The audit included expenses claimed on QSAC’s CFR for the fiscal year ended June 30, 2015. About the Program … and adults with autism. QSAC’s administrative office for all programs is located in Manhattan. QSAC was …
https://www.osc.ny.gov/state-agencies/audits/2019/12/31/quality-services-autism-community-compliance-reimbursable-cost-manualMedicaid Program – Improper Fee-for-Service Payments for Services Covered by Long-Term Care Plans
… payments for certain services covered by managed long-term care (MLTC) plans. The audit covered the period January 1, … are enrolled in MLTC plans. MLTC plans provide long-term care services, such as home health care, nursing home care, and durable medical equipment, to …
https://www.osc.ny.gov/state-agencies/audits/2020/01/17/medicaid-program-improper-fee-service-payments-services-covered-long-term-care-plansAdministration of the Contract With the Postgraduate Center for Mental Health (Follow-Up)
… Objective To determine the extent of implementation of the nine recommendations included in our initial audit … To determine the extent of implementation of the nine recommendations included in our …
https://www.osc.ny.gov/state-agencies/audits/2020/09/15/administration-contract-postgraduate-center-mental-health-followImproper Medicaid Payments for Individuals Receiving Hospice Services Covered by Medicare (Follow-Up)
… Improper Medicaid Payments for Individuals Receiving Hospice Services Covered by Medicare (Report 2018-S-71 ). About the Program Hospice is a coordinated program of home and/or inpatient … that treats terminally ill individuals and their families. Hospice programs provide palliative care, including nursing, …
https://www.osc.ny.gov/state-agencies/audits/2023/02/13/improper-medicaid-payments-individuals-receiving-hospice-services-covered-medicare-follow