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United HealthCare Insurance Company of New York – Empire Plan Drug Rebates (Follow-Up)
… made in our audit report, United HealthCare Insurance Company of New York: Empire Plan Drug Rebates (Report 2014-S-62). … by drug manufacturers. In 2012, Express Scripts Holding Company (Express Scripts) acquired Medco. Our initial audit … made in our audit report United HealthCare Insurance Company of New York Empire Plan Drug Rebates …
https://www.osc.ny.gov/state-agencies/audits/2017/05/24/united-healthcare-insurance-company-new-york-empire-plan-drug-rebates-followMedicaid Program – Medicaid Claims Processing Activity October 1, 2015 Through March 31, 2016
… system processes Medicaid claims submitted by providers for services rendered to Medicaid-eligible recipients, and it generates payments to reimburse the providers for their claims. During the six-month period ended March 31, … Medicaid payments, as follows: $3,521,562 in overpayments for fee-for-service claims for recipients whose services were …
https://www.osc.ny.gov/state-agencies/audits/2016/11/30/medicaid-program-medicaid-claims-processing-activity-october-1-2015-through-march-31-2016Facility Structure, Safety, and Health Code Waivers (Follow-Up)
… waived at those facilities. Further, there was limited assurance that violations were corrected or mitigated during …
https://www.osc.ny.gov/state-agencies/audits/2016/12/08/facility-structure-safety-and-health-code-waivers-followTrash Can Free Stations Pilot Program (Follow-Up)
… Purpose To determine the extent of implementation of the three recommendations included in our initial report, … limitations in Transit’s methods to evaluate the progress of the Pilot Program. Consequently, it was unclear whether … To determine the extent of implementation of the three recommendations included in …
https://www.osc.ny.gov/state-agencies/audits/2017/02/14/trash-can-free-stations-pilot-program-followAdministration of the Article 8-A Loan Program (Follow-Up)
… Purpose To determine the extent of implementation of the recommendations in our initial audit report, Administration of the Article 8-A Loan Program (Report 2013-N-4). Background … To determine the extent of implementation of the recommendations in our initial audit …
https://www.osc.ny.gov/state-agencies/audits/2017/04/12/administration-article-8-loan-program-followOversight of Homeless Shelters (Follow-Up)
… – estimated at more than 80,000 and comprised of families, couples, and single adults – while guiding them to …
https://www.osc.ny.gov/state-agencies/audits/2017/06/27/oversight-homeless-shelters-followImproper Payments to a Physical Therapist (Follow-Up)
… Mark Amir, a physical therapist who owned and operated Madison Physical Therapy located in Brooklyn, New York, billed Medicaid in accordance with its … that were rendered by other clinicians working for Madison Physical Therapy. In our initial audit report, we …
https://www.osc.ny.gov/state-agencies/audits/2016/12/08/improper-payments-physical-therapist-followOverpayments to Managed Care Organizations and Hospitals for Low Birth Weight Newborns (Follow-Up)
… Purpose To determine the extent of implementation of the four … included in our initial audit report, Overpayments to Managed Care Organizations and Hospitals for Low Birth … To determine the extent of implementation of the four …
https://www.osc.ny.gov/state-agencies/audits/2016/12/07/overpayments-managed-care-organizations-and-hospitals-low-birth-weight-newborns-followExamination of Unemployment Insurance Willful Overpayments
… overpayment resulting from a willful misrepresentation, a penalty shall be imposed on the claimant. Key Findings We … up to $311,775 in penalties—more than 10 percent of the penalty amount we examined. This includes up to 1,679 … incorrectly, but these recording errors did not affect the penalty amount. We found these errors were caused by either …
https://www.osc.ny.gov/state-agencies/audits/2018/09/25/examination-unemployment-insurance-willful-overpaymentsExamination of Travel Expenses
… the employee’s usual work location. If an employee works at more than one location, the employee’s official … will normally be the employee’s main place of business (i.e., the place where the employee works more than any other work location). Such designation is …
https://www.osc.ny.gov/state-agencies/audits/2018/07/26/examination-travel-expensesMedicaid Claims Processing Activity October 1, 2011 Through March 31, 2012
… (intensive) levels of care that should have been based on less costly "alternate" levels of care, which caused …
https://www.osc.ny.gov/state-agencies/audits/2013/07/09/medicaid-claims-processing-activity-october-1-2011-through-march-31-2012Medicaid Program – Medicaid Claims Processing Activity April 1, 2011 Through September 30, 2011
… (intensive) levels of care that should have been based on less costly "alternate" levels of care; Claims for a …
https://www.osc.ny.gov/state-agencies/audits/2013/01/10/medicaid-program-medicaid-claims-processing-activity-april-1-2011-through-september-30-2011Medicaid Program – Medicaid Claims Processing Activity April 1, 2013 Through September 30, 2013
… Purpose To determine whether the Department of Health’s eMedNY system … Medicaid requirements, and resulted in correct payments to the providers. The audit covered the period April 1, 2013 … claims submitted by providers for services rendered to Medicaid-eligible recipients, and it generates payments to …
https://www.osc.ny.gov/state-agencies/audits/2015/02/05/medicaid-program-medicaid-claims-processing-activity-april-1-2013-through-september-30-2013MTA-NYC Transit Medical Assessment Centers
… operate a bus carrying passengers. One of the requirements is passing a medical examination every two years. Other … can be for pre-employment to determine if there is some medical reason that a person may not be qualified for … at one of Transit’s five MAC locations. In addition, there is a 24-hour lab located in Downtown Brooklyn. Employees are …
https://www.osc.ny.gov/state-agencies/audits/2014/11/10/mta-nyc-transit-medical-assessment-centersCollection and Use of Oil Spill Funds
… and Spill Compensation Fund (Oil Spill Fund or Fund) in compliance with applicable laws and if all expenditures … to MOSFs for each barrel of petroleum imported for use in the State. The Fund also collects fees from PBS facilities … for spills, $8 million from PBS facilities, and $5 million in federal disaster relief funding. For the same period, the …
https://www.osc.ny.gov/state-agencies/audits/2015/08/13/collection-and-use-oil-spill-fundsMedicaid Program – Medicaid Claims Processing Activity October 1, 2013 Through March 31, 2014
… Purpose To determine whether the Department of Health’s eMedNY system … Medicaid requirements, and resulted in correct payments to the providers. The audit covered the period October 1, … claims submitted by providers for services rendered to Medicaid-eligible recipients, and it generates payments to …
https://www.osc.ny.gov/state-agencies/audits/2015/05/21/medicaid-program-medicaid-claims-processing-activity-october-1-2013-through-march-31-2014Housing Preferences for Disabled Veterans (Follow-Up)
… two recommendations included in our initial audit report, Housing Preference for Disabled Veterans (2010-S-42). Background In November 2007, the Private Housing Law was amended to require housing companies to provide disabled veterans with a … two recommendations included in our initial audit report Housing Preference for Disabled Veterans 2010S42 …
https://www.osc.ny.gov/state-agencies/audits/2013/02/19/housing-preferences-disabled-veterans-followMedicaid 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-limitsQuality of Internal Control Certifications (Follow-Up)
… their 2011-2012 Internal Control Certifications submitted to the Division of the Budget (DOB). We examined whether … (OWIG) (2012-S-42) The objective of our follow-up was to determine the degree of implementation by each agency in … audit reports concluded that improvements were needed to the quality of Internal Control Certifications at 10 of …
https://www.osc.ny.gov/state-agencies/audits/2015/07/07/quality-internal-control-certifications-followWage Theft Investigations (Follow-Up)
… of 17,191 cases, including 9,331 active investigations and 7,860 cases pending payment. Of these, 12,938 cases (75 … system did not provide management with accurate or useful case management reports. Key Findings We determined that the … reports that track information to monitor these plans and alert senior management to accounts in arrears. Other Related …
https://www.osc.ny.gov/state-agencies/audits/2015/05/22/wage-theft-investigations-follow