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Improper Medicaid Payments Involving Fee-for-Service Claims for Recipients With Multiple Client Identification Numbers (Follow-Up)
… of implementation of the six recommendations included in our initial audit report, Improper Medicaid Payments … the State’s Medicaid program. Individuals may enroll in Medicaid through Local Departments of Social Services or … than one CIN assigned to them during the time they are in receipt of benefits; however, only one CIN should have …
https://www.osc.ny.gov/state-agencies/audits/2022/09/08/improper-medicaid-payments-involving-fee-service-claims-recipients-multiple-clientOversight of Mitchell-Lama Application Fees
… rental and cooperative housing to middle-income families. In New York City, there are 93 HPD-supervised Mitchell-Lama … collected application fees of up to $200 per applicant. (In August 2019, this was reduced to a non-refundable $75.) … by lottery. Our audit at three housing developments in Manhattan focused on waiting lists that were current as of …
https://www.osc.ny.gov/state-agencies/audits/2019/12/20/oversight-mitchell-lama-application-feesContracts for Personal and Miscellaneous Services (Follow-Up)
… ( 2008-S-158 ). Background Our initial report, issued on September 14, 2009, determined that while the Metropolitan … expenses. This could help the MTA to close budget gaps. Key Finding The MTA made some progress in implementing the … one was not implemented, and one is no longer applicable. Key Recommendation Officials are given 30 days after the …
https://www.osc.ny.gov/state-agencies/audits/2015/01/06/contracts-personal-and-miscellaneous-services-followSafety of Infrastructure (Follow-Up)
… the two recommendations included in our original report, Safety of Infrastructure (2012-S-29). Background Our initial … was maintaining its infrastructure to preserve park safety by properly inspecting and repairing any hazardous … amenities or even sections of the parks to ensure public safety. We found Parks needed to establish principles to …
https://www.osc.ny.gov/state-agencies/audits/2015/01/06/safety-infrastructure-followMedicaid Payments for Excessive Dental Services (Follow-Up)
… our initial audit report, Medicaid Payments for Excessive Dental Services (Report 2009-S-46). Background Our initial … on August 16, 2010, examined Medicaid payments for routine dental services, such as cleanings and oral evaluations, … 31, 2009. Our audit identified $40 million of excessive dental services that exceeded certain frequency limits (i.e., …
https://www.osc.ny.gov/state-agencies/audits/2013/04/10/medicaid-payments-excessive-dental-services-followAssessment of Costs to Administer the Workers’ Compensation Program for the Two Fiscal Years Ended March 31, 2013
… related to administration of Sections 50(5), 151, and 228 of the Workers’ Compensation Law and Section 60 of both …
https://www.osc.ny.gov/state-agencies/audits/2015/04/15/assessment-costs-administer-workers-compensation-program-two-fiscal-years-ended-march-31Under Reporting of Net Available Monthly Income for Nursing Home Residents Causes Medicaid Overpayments (Follow-Up)
… Reporting of Net Available Monthly Income for Nursing Home Residents Causes Medicaid Overpayments (Report … net available monthly income. Many Medicaid nursing home recipients have income from Social Security, pensions … and other sources to offset the cost of their nursing home care. This is referred to as net available monthly …
https://www.osc.ny.gov/state-agencies/audits/2013/08/16/under-reporting-net-available-monthly-income-nursing-home-residents-causes-medicaidAccuracy of Reported Cost Savings
… local law enforcement agencies. These activities result in reported cost savings to the Medicaid program. There are … $1.2 billion as a result of flaws and/or inconsistencies in the methodologies used to estimate savings. OMIG officials … to identify and correct inconsistencies and inaccuracies in methodologies. Routinely take steps to identify changes in …
https://www.osc.ny.gov/state-agencies/audits/2014/07/11/accuracy-reported-cost-savingsEducators for Children, Youth and Families, Inc. – Use of Contract Funds (Follow-Up)
… and Families, Inc. - Use of Contract Funds (Report 2007-S-128). Background Our initial audit report, which was issued … Youth and Families, Inc. - Use of Contract Funds (2007-S-128) …
https://www.osc.ny.gov/state-agencies/audits/2013/08/13/educators-children-youth-and-families-inc-use-contract-funds-followCollege of Optometry – Selected Employee Travel Expenses
… and under the control of agency management, include car rentals, meals, lodging, transportation, fuel, and …
https://www.osc.ny.gov/state-agencies/audits/2013/02/14/college-optometry-selected-employee-travel-expensesAssessment of Costs to Administer the Workers’ Compensation Program for the Fiscal Year Ended March 31, 2014
… Purpose The purpose of this performance audit is to determine whether the Workers’ Compensation Board … 2014. Background The primary responsibility of the Board is to ensure that employees who are unable to work due to … Coverage for these benefits, with limited exception, is to be provided by their employers. The Board is also …
https://www.osc.ny.gov/state-agencies/audits/2016/10/26/assessment-costs-administer-workers-compensation-program-fiscal-year-ended-march-31-2014Allocation, Billing, and Collection of Expenses of Administering the Motor Vehicle Financial Security Act and the Motor Vehicle Safety Responsibility Act (Follow-Up)
… ensure that the operators of motor vehicles registered in New York possess adequate insurance coverage, or are … programs and assess these expenses on insurance carriers in proportion to their reported premiums. The objective of … the expenses of administering the Acts. We found that, in general, the Department was appropriately allocating, …
https://www.osc.ny.gov/state-agencies/audits/2021/05/27/allocation-billing-and-collection-expenses-administering-motor-vehicle-financial-securityExamination of Unemployment Insurance Benefit Payments (January 1, 2018 – December 31, 2018)
… and regulations and Department policies and procedures. In addition, we performed data analytics to identify and … payroll information and various information maintained in the Department’s mainframe applications. Key Findings We … overpayments totaling $788,487, which included $55,423 in fraudulent claims, and underpayments totaling $48,728. …
https://www.osc.ny.gov/state-agencies/audits/2019/09/16/examination-unemployment-insurance-benefit-payments-january-1-2018-december-31-2018UnitedHealthcare – Out-of-Network Providers Upcoding Selected Evaluation and Management Services (Follow-Up)
… the primary health benefits plan for NYSHIP. Civil Service contracted with UnitedHealthcare (United) to administer the medical/surgical portion of the … 40-minute visit). The higher the level billed, the greater United’s reimbursement. Billing for a higher level of care …
https://www.osc.ny.gov/state-agencies/audits/2020/01/03/unitedhealthcare-out-network-providers-upcoding-selected-evaluation-and-management-servicesMedicaid Program – Claims Processing Activity April 1, 2023 Through September 30, 2023
… processed and paid in weekly cycles, which averaged about 16 million claims and $1.8 billion in payments to providers. …
https://www.osc.ny.gov/state-agencies/audits/2024/04/24/medicaid-program-claims-processing-activity-april-1-2023-through-september-30-2023Medicaid Program – Improper Payments for Brand Name Drugs
… drugs containing the same active ingredients, dosage form, and strength. Generally, this means a brand name drug …
https://www.osc.ny.gov/state-agencies/audits/2022/12/13/medicaid-program-improper-payments-brand-name-drugsCompliance With Requirements to Maintain Systems at Vendor-Supported Levels
… Objective To determine whether the Rochester-Genesee Regional Transportation Authority (RGRTA) …
https://www.osc.ny.gov/state-agencies/audits/2019/07/29/compliance-requirements-maintain-systems-vendor-supported-levelsInappropriate Payments Related to Procedure Modifiers (Follow-Up)
… (Report 2016-S-63 ). About the Program The Department of Health (Department) administers the State’s Medicaid program, … E/M services unrelated to the original procedure that occur during the global surgery period may be reported, … and recover the inappropriate payments we identified and advise providers to report accurate claim information when …
https://www.osc.ny.gov/state-agencies/audits/2019/07/31/inappropriate-payments-related-procedure-modifiers-followRegistration and Enforcement of Automotive Service, Sales, and Salvage Facilities (Follow-Up)
… of implementation of the three recommendations included in our initial audit report, Registration and Enforcement of … businesses it regulates. Where facilities are found to be in violation of laws, rules, or regulations, the Department … be operating without a license. We also identified delays in the Department’s process for handling consumer complaints. …
https://www.osc.ny.gov/state-agencies/audits/2018/12/11/registration-and-enforcement-automotive-service-sales-and-salvage-facilities-followProcurement Practices
… assurance that funds are spent appropriately, are in the best interest of the State, and adequately safeguard … of New York public higher education system. Specializing in research and medicine, Buffalo serves more than 31,000 … and employs more than 2,500 faculty on its three campuses. In support of its mission, Buffalo spent nearly $330 million …
https://www.osc.ny.gov/state-agencies/audits/2019/10/03/procurement-practices