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Medicaid Program – Medicaid Payments for Pharmacy Claims: Joia Pharmacy and a Related Prescriber
… the Department paid Joia more than $7.7 million for 50,060 claims on behalf of 706 recipients. The Doctor was listed as the prescriber on 31,351 (63 percent) of the 50,060 claims. Key Findings Based on a statistical projection of our … Department overpaid Joia $1,485,121 for improper pharmacy claims. Disallowances included: Claims billed for excess …
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
… diagnosed with end stage renal disease who were eligible for, but not enrolled in, Medicare. The audit covered the … requires dialysis or a kidney transplant to stay alive. For the six-year period ended December 31, 2015, Medicaid paid $909 million for medical services (including inpatient, clinic, …
https://www.osc.ny.gov/state-agencies/audits/2017/03/01/medicaid-program-reducing-medicaid-costs-recipients-end-stage-renal-diseaseOversight of Hotels and Motels Used for Homeless and Mixed-Use Temporary Residency
… of Health (DOH) are adequately ensuring that hotels and motels used for homeless and mixed-use temporary residency … report, of the more than 86,000 homeless people in New York State, almost 13,000 (15 percent) are located in areas outside of New York City (NYC). Counties throughout the State utilize hotels …
https://www.osc.ny.gov/state-agencies/audits/2017/06/27/oversight-hotels-and-motels-used-homeless-and-mixed-use-temporary-residencyLifeline Center for Child Development, Inc. – Compliance With the Reimbursable Cost Manual
… 30, 2015, Lifeline reported approximately $9.8 million in reimbursable costs for the SED preschool cost-based … fiscal years ended June 30, 2015, we identified $304,192 in reported costs that did not comply with the guidelines in the Manual, as follows: $80,506 in bonuses, including …
https://www.osc.ny.gov/state-agencies/audits/2017/10/12/lifeline-center-child-development-inc-compliance-reimbursable-cost-manualBrookville Center for Children’s Services, Inc. – Compliance With the Reimbursable Cost Manual
… determine whether the costs reported by Brookville Center for Children’s Services, Inc. (Brookville) on its … The audit included expenses claimed on Brookville’s CFR for the fiscal year ended June 30, 2014, and certain expenses … NYSARC, Inc. - Nassau County Chapter (AHRC), a related party, provided Brookville with management services under the …
https://www.osc.ny.gov/state-agencies/audits/2017/10/04/brookville-center-childrens-services-inc-compliance-reimbursable-cost-manualPayments for Fraudulent and Improper Claims Submitted by Davis Ethical Pharmacy (Follow-Up)
… Purpose To determine the extent of implementation of the three recommendations included in our initial audit report, Payments for Fraudulent and … 10, 2015, William Davis pleaded guilty to Grand Larceny in the Second Degree in Nassau County District Court. He was …
https://www.osc.ny.gov/state-agencies/audits/2016/02/18/payments-fraudulent-and-improper-claims-submitted-davis-ethical-pharmacy-followDiNapoli Statement on Greenville Arrest for Alleged Theft of Taxpayer Funded Resources
… DiNapoli said. "Thanks to my ongoing partnership with the New York State Police, Mr. Williams' alleged acts …
https://www.osc.ny.gov/press/releases/2018/07/dinapoli-statement-greenville-arrest-alleged-theft-taxpayer-funded-resourcesDiNapoli Announces Interim CIO for the New York State Common Retirement Fund
… New York State Comptroller Thomas P. DiNapoli today announced … is the third largest public pension fund in the United States, with an audited value of $207.4 billion as of March …
https://www.osc.ny.gov/press/releases/2018/07/dinapoli-announces-interim-cio-new-york-state-common-retirement-fundChanges in Federal Policies Pose Significant Risks for New York City's Budget
… Projected budget gaps for New York City in the coming years appear manageable, but tax … growth has come primarily in the business services, health care, and leisure and hospitality sectors, which have …
https://www.osc.ny.gov/press/releases/2017/12/changes-federal-policies-pose-significant-risks-new-york-citys-budgetMedicaid Program – Improper Fee-for-Service Payments for Pharmacy Services Covered by Managed Care
… for pharmacy services covered by recipients’ managed care plans. The audit covered the period October 1, 2011 … care needs. In general, the Medicaid program pays medical providers through either the fee-for-service method or the …
https://www.osc.ny.gov/state-agencies/audits/2015/01/05/medicaid-program-improper-fee-service-payments-pharmacy-services-covered-managed-careDiNapoli: Contractor Sentenced in Federal Court for Defrauding State of Over $360,000
… Comptroller Thomas P. DiNapoli and U.S. Attorney for the Southern District Preet Bharara, was sentenced today to a … Junkovic defrauded the state by billing for thousands of hours that he did not work while he took overseas vacations … went as far as billing the state for working over 24 hours a day on a few occasions. This is the latest example of …
https://www.osc.ny.gov/press/releases/2014/09/dinapoli-contractor-sentenced-federal-court-defrauding-state-over-360000United HealthCare – Overpayments for Services Provided by Orthopedic Associates of Long Island
… and if so, to quantify the overpayments made by United HealthCare resulting from this practice. The audit covered … providers. In accordance with the Empire Plan’s requirements, when United processes a non-participating provider’s claims, it is with the understanding that Empire Plan …
https://www.osc.ny.gov/state-agencies/audits/2016/05/05/united-healthcare-overpayments-services-provided-orthopedic-associates-long-islandDiNapoli Proposal Would Provide More Accountability for Personal Income Tax Check-Off Funds
… within the year they were made and report how the money was spent to the public and state officials. “New … on their personal income tax forms, but too much of this money remains unused when it should be fighting cancer, … who donate to these causes have a right to expect their money is being used efficiently and effectively to address …
https://www.osc.ny.gov/press/releases/2015/04/dinapoli-proposal-would-provide-more-accountability-personal-income-tax-check-fundsImproper Medicaid Payments for Individuals Receiving Hospice Services Covered by Medicare (Follow-Up)
… About the Program Hospice is a coordinated program of home and/or inpatient care that treats terminally ill individuals and their families. Hospice programs provide palliative care, including nursing, physician, and counseling services; home health aides; physical and …
https://www.osc.ny.gov/state-agencies/audits/2023/02/13/improper-medicaid-payments-individuals-receiving-hospice-services-covered-medicare-followDiNapoli: Livingston County Woman Arrested for Theft of Deceased Mother's Pension Payments
… New York State Comptroller Thomas P. DiNapoli, Livingston … became aware of Janet Chatley’s death after receiving an anonymous complaint. According to the investigation, between …
https://www.osc.ny.gov/press/releases/2024/01/dinapoli-livingston-county-woman-arrested-theft-deceased-mothers-pension-paymentsDiNapoli: State Needs to Help Addiction Support Providers Better Prepare for Emergencies
… treatment programs may not be adequately prepared in an emergency to prevent gaps in care, which could compromise patient progress or safety, … “The COVID-19 pandemic led to significant disruptions in addiction care and services, leaving many vulnerable New …
https://www.osc.ny.gov/press/releases/2023/11/dinapoli-state-needs-help-addiction-support-providers-better-prepare-emergenciesDiNapoli: State Missing Out on Millions in Medicare Payments for Kidney Patients
… from 2016 to 2018, which includes $17 million in savings for counties and New York City. "New Yorkers dealing with … expenses and may provide them with more options for care." DiNapoli said. "The state has an obligation not … health care needs. The program is administered by DOH. For the fiscal year ended March 31, 2016, New York's Medicaid …
https://www.osc.ny.gov/press/releases/2017/03/dinapoli-state-missing-out-millions-medicare-payments-kidney-patientsMedicaid Program – Improper Medicaid Payments for Outpatient Services Billed as Inpatient Claims
… records. For these 190 claims, 91 claims (48%), totaling $1,577,821, were billed improperly. Key Recommendations …
https://www.osc.ny.gov/state-agencies/audits/2023/08/30/medicaid-program-improper-medicaid-payments-outpatient-services-billed-inpatient-claimsMedicaid Program – Improper Fee-for-Service Pharmacy Payments for Recipients With Third-Party Health Insurance
… (e.g., employer-based coverage, Medicare Part D). Medicaid is considered the payer of last resort and, as such, FFS …
https://www.osc.ny.gov/state-agencies/audits/2023/05/11/medicaid-program-improper-fee-service-pharmacy-payments-recipients-third-party-healthDiNapoli: Orange County Resident Arrested for Stealing Her Late Mother’s Pension Benefits
… Thomas P. DiNapoli, Orange County District Attorney David M. Hoovler, and the New York State Police today … protecting public funds,” Orange County District Attorney David Hoovler said. Betty James died on April 11, 2017, but …
https://www.osc.ny.gov/press/releases/2021/06/dinapoli-orange-county-resident-arrested-stealing-her-late-mothers-pension-benefits