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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 place to … are economically disadvantaged and/or have special health care needs. The Department administers New York’s Medicaid … claim costs totaled over $58 billion, of which managed care accounted for about $34 billion. Under managed care, …
https://www.osc.ny.gov/state-agencies/audits/2018/02/26/medicaid-program-managed-care-organizations-payments-ineligible-providersPurchasing Practices at the Linden Plaza Mitchell-Lama Housing Development
… $33 million; $22.3 million was for services such as mortgage payments, insurance, and utilities. Our audit …
https://www.osc.ny.gov/state-agencies/audits/2018/09/06/purchasing-practices-linden-plaza-mitchell-lama-housing-developmentSelected Management and Operations Practices (Follow-Up)
… and it had poor controls over the disposition of fleet vehicles. NYPA's claimed energy efficiency savings were …
https://www.osc.ny.gov/state-agencies/audits/2018/12/11/selected-management-and-operations-practices-followTrain On-Time Performance (Follow-up)
… Purpose To determine the extent of implementation of the two recommendations included in our initial report, … actual On-Time Performance (OTP) was well below the goal of 91.9 percent. For 2013, weekday OTP averaged 80.5 percent … To determine the extent of implementation of the two recommendations included in our …
https://www.osc.ny.gov/state-agencies/audits/2017/09/27/train-time-performance-followSubway Wait Assessment (Follow-Up)
… City 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-followAssessment and Collection of Selected Penalties
… a $50 penalty (HP-1 penalty) on the carrier. The proceeds of these penalties are to be deposited in the State's general … it has not been making sufficient efforts to collect all of the penalties owed. WCB does not take any enforcement … the carriers without any follow-up collection efforts. As of October 18, 2011, there were 26,981 HP-1 penalties …
https://www.osc.ny.gov/state-agencies/audits/2013/09/24/assessment-and-collection-selected-penaltiesMedicaid Program – Overpayments of Ambulatory Patient Group Claims
… (Department) in an effort to more accurately pay providers for services rendered. Prior to the APG implementation, … services were paid under an all-inclusive reimbursement model. The patient's condition and complexity of service were … to deny claims with the prohibited rate code combinations. For example, Medicaid paid a provider $149 for a clinic visit …
https://www.osc.ny.gov/state-agencies/audits/2013/08/20/medicaid-program-overpayments-ambulatory-patient-group-claimsMedicaid Program - Medicaid Overpayments for Certain Medicare Part C Claims
… identify Medicaid overpayments made to medical providers for services rendered to recipients enrolled in UnitedHealthcare’s Medicare Advantage plan: … of participating providers they reimburse directly for services provided to enrollees. For dual-eligibles, plan …
https://www.osc.ny.gov/state-agencies/audits/2015/01/16/medicaid-program-medicaid-overpayments-certain-medicare-part-c-claimsSelected Financial Management and Administrative Practices
… Administrator is responsible for distributing any residual value to estate beneficiaries. Any unclaimed funds are … by a fee set by the Surrogate’s Court on the closing value of each administered estate. As of December 31, 2013, … also did not maintain written documentation justifying the selection of particular vendors as required by the governing …
https://www.osc.ny.gov/state-agencies/audits/2015/04/28/selected-financial-management-and-administrative-practicesMedicaid Overpayments for Non-Emergency Out-of-State Inpatient Services (Follow-Up)
… of the four recommendations included in our initial audit report, Medicaid Overpayments for Non-Emergency Out-of-State Inpatient Services (Report 2009-S-35). Background Our initial audit report, which … of the 4 recommendations included in our initial audit report Medicaid Overpayments for NonEmergency OutofState Inpat …
https://www.osc.ny.gov/state-agencies/audits/2013/03/11/medicaid-overpayments-non-emergency-out-state-inpatient-services-followMedicaid Overpayments for Out-of-State Ambulatory Surgery Services (Follow-Up)
… Purpose To determine the extent of implementation of the two recommendations included in our initial audit report, … extent of implementation, as of September 30, 2012, of the two recommendations included in our initial report. Key … audit. This included the recovery of $1,309,960. Of the two prior audit recommendations, both have been implemented. …
https://www.osc.ny.gov/state-agencies/audits/2013/01/10/medicaid-overpayments-out-state-ambulatory-surgery-services-followBus Driver Licensing (Follow-Up)
… the four recommendations included in our initial report, Bus Driver Licensing (2012-S-30). Background Our initial … on June 13, 2013, determined that the majority of MTA bus drivers we sampled met the requirements of Article 19-A … of the 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-followForensic Audit of Select Payroll and Overtime Practices and Related Transactions (Follow-Up)
… (2010-S-60). Background Our initial report, issued on November 9, 2011, determined that certain Metro-North … issuance of the follow-up review to provide information on any action planned to address the unresolved issues … Interest MTA- Metro-North: Forensic Audit of Payments to On-Board Service Managers (Follow-up) ( 2015-F-15 ) …
https://www.osc.ny.gov/state-agencies/audits/2016/03/18/forensic-audit-select-payroll-and-overtime-practices-and-related-transactions-followEmpire BlueCross BlueShield – Selected Payments for Special Items for the Period January 1, 2012 Through June 30, 2012 (Follow-Up)
… coverage to active and retired State, participating local government and school district employees, and their … accordance with agreements Empire negotiates with member hospitals. Payments for hospital services are generally based … are negotiated between Empire and its member providers. Hospitals may be entitled to additional payments for special …
https://www.osc.ny.gov/state-agencies/audits/2015/12/28/empire-bluecross-blueshield-selected-payments-special-items-period-january-1-2012-throughSuspicious and Fraudulent Medicaid Payments to Affiliated Brooklyn Dentists (Follow-Up)
… Suspicious and Fraudulent Medicaid Payments to Affiliated Brooklyn Dentists (Report 2010-S-64). Background The … Lawrence Bruckner operated two office locations in Brooklyn, NY. Other dentists who reportedly practiced at the … services purportedly performed by the six dentists at the Brooklyn offices. Our initial audit report, which was issued …
https://www.osc.ny.gov/state-agencies/audits/2015/12/30/suspicious-and-fraudulent-medicaid-payments-affiliated-brooklyn-dentists-followUnited HealthCare – Payments for Fraudulent and Improper Claims Submitted by Davis Ethical Pharmacy (Follow-Up)
… Department of Financial Services. On December 10, 2015, William Davis, former owner Davis Ethical Pharmacy, pleaded … in the Second Degree in Nassau County District Court. William Davis was sentenced on February 9, 2016 and made … we did not test, and formally assess the conduct of William Davis. Key Finding United officials made progress …
https://www.osc.ny.gov/state-agencies/audits/2016/02/18/united-healthcare-payments-fraudulent-and-improper-claims-submitted-davis-ethical-pharmacyAccess-A-Ride Accident Claims (Follow-Up)
… traditional carriers decreased and reliance on the black car services and taxis increased. The number of reported … was an unquantified liability risk associated with black car services and taxis that was expanding and was not being …
https://www.osc.ny.gov/state-agencies/audits/2016/05/13/access-ride-accident-claims-followBenefit Eligibility Assessment Process (Follow-Up)
… Fair Hearings. These hearings were unnecessary because the case had either already been resolved to the client’s … satisfaction, or HRA could not proceed due to missing case file support or erroneously prepared documents. We also found that OTDA’s closed-case coding system did not always adequately describe the …
https://www.osc.ny.gov/state-agencies/audits/2016/06/16/benefit-eligibility-assessment-process-followCompliance With Payment Card Industry Standards
… of New York (SUNY) schools are in compliance with Payment Card Industry (PCI) standards and whether SUNY System Administration has provided … All industries that accept credit cards as a method of payment must comply with the Data Security Standards (DSS) … University of New York schools are in compliance with Payment Card Industry standards and whether …
https://www.osc.ny.gov/state-agencies/audits/2016/06/08/compliance-payment-card-industry-standardsAdministration of Tenant Complaints
… New York State Homes and Community Renewal’s Office of Rent Administration addresses tenant complaints in a timely … housing in New York State. The Division’s Office of Rent Administration (Office), the subject of this audit, is responsible for administering New York State’s rent laws. These laws are designed to provide decent, …
https://www.osc.ny.gov/state-agencies/audits/2014/12/11/administration-tenant-complaints