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Improper Payments for Services Related to Ordering, Prescribing, Referring, or Attending Providers No Longer Participating in the Medicaid Program (Follow-Up)
… been recovered and, we note, the Office of the Medicaid Inspector General (OMIG) was unable to demonstrate that any …
https://www.osc.ny.gov/state-agencies/audits/2024/01/03/improper-payments-services-related-ordering-prescribing-referring-or-attending-providers-noDiNapoli: Tennessee Woman Pleads Guilty to Wire Fraud for Receiving Deceased Mother's New York State and Local Retirement System Benefits
… (18 USC. § 1343) in the U.S. District Court at Knoxville, TN for stealing $56,352 from the New York State and Local … account with her daughter, Schwinzer, 46, of Madisonville, TN. Schwinzer failed to notify NYSLRS and the Social Security … fraud 18 USC 1343 in the US District Court at Knoxville TN for stealing $56352 …
https://www.osc.ny.gov/press/releases/2022/03/dinapoli-tennessee-woman-pleads-guilty-wire-fraud-receiving-deceased-mothers-new-york-state-and-localAn Analysis of Reasonable and Customary Out-of-Network Reimbursement Rates for Medical/Surgical Services in the New York State Health Insurance Program
… its members with four types of health insurance coverage: medical/surgical, hospital, prescription drugs, and mental … contracts with UnitedHealthcare (United) to administer the medical/ surgical portion of the Empire Plan. Medical/surgical benefits cover a range of services …
https://www.osc.ny.gov/state-agencies/audits/2020/04/01/analysis-reasonable-and-customary-out-network-reimbursement-rates-medicalsurgical-servicesImproper Medicaid Payments for Claims Not in Compliance With Ordering, Prescribing, Referring, and Attending Requirements (2019-S-2) 180-Day Response
To determine whether the Department of Health (Department) paid for claims in violation of federal and State regulations that require an appropriate National Provider Identifier (NPI) for ordering, prescribing, referring, and attending (OPRA) health care providers.
https://www.osc.ny.gov/files/state-agencies/audits/pdf/sga-2021-19s2-response.pdfState Agencies Bulletin No. 2242
… the end of the Summer Session. A teacher who is appointed only for the Summer Session and is not continuing in the fall …
https://www.osc.ny.gov/state-agencies/payroll-bulletins/state-agencies/2242-procedures-processing-2024-summer-session-payments-institution-teachersMedicaid Program - Overpayments to Managed Care Organizations and Hospitals for Low Birth Weight Newborns (2013-S-57), 90-Day Response
To determine if Medicaid overpaid managed care organizations and hospitals for low birth weight newborn claims.
https://www.osc.ny.gov/files/state-agencies/audits/pdf/sga-2015-13s57-response.pdfMedicaid Program - Excessive Medicaid Payments to Federally Qualified Health Centers for Group Therapy Services (2013-S-51), 90-Day Response
To determine if Medicaid reimbursement rates for group therapy services provided by Federally Qualified Health Centers were correctly applied
https://www.osc.ny.gov/files/state-agencies/audits/pdf/sga-2015-13s51-response.pdfMedicaid Program - Ambulatory Patient Groups Payments for Duplicate Claims and Services in Excess of Medicaid Service Limits (2013-S-17)
To determine whether the Department of Health established adequate controls to prevent duplicate and excessive Medicaid payments to clinics and outpatient facilities reimbursed by the Ambulatory Patient Groups (APG) payment methodology.
https://www.osc.ny.gov/files/state-agencies/audits/pdf/sga-2015-13s17.pdfMedicaid Program - Questionable Payments for Practitioner Services and Pharmacy Claims Pertaining to a Selected Physician (2012-S-35), 90-Day Response
To determine if Dr. Riaz Ahmad complied with Medicaid policies and whether Dr. Ahmad’s medical records support the services he billed and the prescriptions he w
https://www.osc.ny.gov/files/state-agencies/audits/pdf/sga-2015-12s35-response.pdfSelected Payments for Special Items Made to St. Luke’s Cornwall Hospital from January 1, 2011 through March 31, 2011(2012-S-58)
This report is part of a series of audits of Empire’s payments to selected hospitals for “special items” during the three months ended March 31, 2011.
https://www.osc.ny.gov/files/state-agencies/audits/pdf/sga-2013-12s58.pdfSelected Payments for Special Items Made to St. Peter’s Hospital from January 1, 2011 through March 31, 2011 (2012-S-62)
This report is part of a series of audits of Empire’s payments to selected hospitals for “special items” during the three months ended March 31, 2011.
https://www.osc.ny.gov/files/state-agencies/audits/pdf/sga-2012-12s62.pdfSelected Payments for Special Items Made to St. Mary’s Hospital from January 1, 2011 through March 31, 2011 (2012-S-57)
This report is part of a series of audits of Empire’s payments to selected hospitals for “special items” during the three months ended March 31, 2011.
https://www.osc.ny.gov/files/state-agencies/audits/pdf/sga-2012-12s57.pdfSelected Payments for Special Items Made to Arden Hill Hospital from January 1, 2011 through March 31, 2011 (2012-S-54)
We audited selected claim payments made by Empire BlueCross BlueShield (Empire) to Arden Hill Hospital (Arden Hill) on behalf of the New York State Health Insur
https://www.osc.ny.gov/files/state-agencies/audits/pdf/sga-2012-12s54.pdfCalendar Year Municipalities That Have Not Filed in Time For a FSMS Score in All Three Years, 2012 through 2014
Calendar Year Municipalities That Have Not Filed in Time For a FSMS Score in All Three Years, 2012 through 2014
https://www.osc.ny.gov/files/local-government/publications/pdf/persistentnonfilingmunis.pdfThree Years of the Fiscal Stress Monitoring System - Results for Municipalities with Fiscal Years Ending on December 31, 2014
In September 2015, OSC released the third annual set of Fiscal Stress Monitoring System (FSMS) scores
https://www.osc.ny.gov/files/local-government/publications/pdf/threeyearsfsms0915.pdfUnitedHealthcare Insurance Company of New York: Improper Payments for Acupuncture and Acupuncture-Related Services (Follow-Up) (2023-F-14) 30-Day Response
2023-F-14
https://www.osc.ny.gov/files/state-agencies/audits/pdf/sga-2023-23f14-response.pdfExcessive Premium Payments for Dual-Eligible Recipients Enrolled in Mainstream Managed Care and Health and Recovery Plans (Follow-Up) (2023-F-39)
To assess the extent of implementation of the four recommendations included in our initial audit report, Medicaid Program: Excessive Premium Payments for Dual-Eligible Recipients Enrolled in Mainstream Managed Care and Health and Recovery Plans (Report 2021-S-37).
https://www.osc.ny.gov/files/state-agencies/audits/pdf/sga-2024-23f39.pdfInappropriate Premium Payments for Recipients No Longer Enrolled in Mainstream Managed Care and Family Health Plus (Follow-Up) (2019-F-20)
To determine the extent of implementation of the five recommendations made in our initial audit report, Inappropriate Premium Payments for Recipients No...
https://www.osc.ny.gov/files/state-agencies/audits/pdf/sga-2020-19f20.pdfWorld Trade Center Notice for Members and Retirees of the New York State and Local Retirement System (RS6047-N)
For NYSLRS members and retirees involved in the rescue, recovery or cleanup operations of the World Trade Center aftermath.
https://www.osc.ny.gov/files/retirement/forms/pdf/rs6047-n.pdfMedicaid Program – Improper Managed Care Premium Payments for Recipients With Duplicate Client Identification Numbers (2018-S-24) 90-Day Response
To determine whether improper Medicaid managed care premiums were paid on behalf of recipients with duplicate Client Identification Numbers (CINs) ...
https://www.osc.ny.gov/files/state-agencies/audits/pdf/sga-2019-18s24-response.pdf