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Medicaid Program – Improper Medicaid Payments for Misclassified Patient Discharges
… to hospitals that failed to properly report correct patient discharge codes on inpatient claims. The audit … providers for their claims. The Department uses the All Patient Refined Diagnosis Related Groups methodology to … reports certain information on its claims, such as the patient’s diagnoses and services received, as well as the …
https://www.osc.ny.gov/state-agencies/audits/2021/08/17/medicaid-program-improper-medicaid-payments-misclassified-patient-dischargesBenefits Advisement Services for Individuals With Disabilities Seeking Employment
… with disabilities participate in the work force at a rate of less than half that of people without disabilities, … with disabilities are more than twice as likely to live in poverty. The New York State Employment First Commission … with disabilities by 5 percent while also decreasing their poverty rate by 5 percent. One way the Report recommended …
https://www.osc.ny.gov/state-agencies/audits/2021/07/20/benefits-advisement-services-individuals-disabilities-seeking-employmentUse of Federal Funding for Election Technology and Security
… to enhance the security of the State’s election technology and infrastructure. The audit covered the period from May 1, … Board of Elections (BOE) is responsible for administering and enforcing election laws in the State. To fulfill these … the BOE supports 57 County Boards of Elections and the New York City Board of Elections (County Boards). …
https://www.osc.ny.gov/state-agencies/audits/2021/09/17/use-federal-funding-election-technology-and-securityUnitedHealthcare – Reasonable and Customary Reimbursement Rates for Delayed Claims
… reimbursement rate schedules that did not correlate with the date of the service on the claims, and to calculate the … benefits portion of the Empire Plan. United contracts with in-network providers to deliver services to Empire Plan … that were paid using an R&C rate period that was not in effect on the date of the service. Key Recommendations …
https://www.osc.ny.gov/state-agencies/audits/2019/12/12/unitedhealthcare-reasonable-and-customary-reimbursement-rates-delayed-claimsMaximizing Drug Rebates for Health and Recovery Plans (Follow-Up)
… initial audit report, Maximizing Drug Rebates for Health and Recovery Plans (Report 2017-S-61 ). About the Program … behavioral health needs began to be enrolled into Health and Recovery Plans (HARPs). HARPs are a type of managed care … recipients age 21 or older with serious mental illness and/or substance use disorders. We issued our initial audit …
https://www.osc.ny.gov/state-agencies/audits/2020/01/17/maximizing-drug-rebates-health-and-recovery-plans-followEmpire BlueCross – Controls Over Payments for Special Items (Follow-Up)
… Objective To assess the extent of implementation of the two … Empire processes claims for hospital services according to contracts it negotiates with member hospitals. Empire’s … outpatient hospital services. Hospitals may be entitled to additional payments for special medical items (implants, …
https://www.osc.ny.gov/state-agencies/audits/2020/02/25/empire-bluecross-controls-over-payments-special-items-followMedicaid Program – Excessive Payments for Durable Medical Equipment Rentals
… paid for durable medical equipment beyond allowed rental limits, and whether the Medicaid program could achieve cost savings by implementation of a rental cap on oxygen equipment. The audit covered the period … items are available to Medicaid recipients on a monthly rental basis, subject to certain limits (or caps). A special …
https://www.osc.ny.gov/state-agencies/audits/2023/04/12/medicaid-program-excessive-payments-durable-medical-equipment-rentalsSelected Aspects of Accommodations for Passengers With Disabilities (Follow-Up)
… stations. We also found that tactile tiles (raised rubber platform edge), which alert travelers with a visual …
https://www.osc.ny.gov/state-agencies/audits/2023/05/12/selected-aspects-accommodations-passengers-disabilities-followAnnual Assessment of Market Orders for 2015 and 2016
… Purpose To determine whether the Department of Agriculture and Markets (Department) had adequate procedures in place … to its administration of Article 25 of the Agriculture and Markets Law. Our audit covered the period July 1, 2014 through June 30, 2016 for the Apple and Sour Cherry Market Orders and the period April 1, 2014 …
https://www.osc.ny.gov/state-agencies/audits/2019/05/16/annual-assessment-market-orders-2015-and-2016Medicaid Overpayments for Inpatient Care Involving Mechanical Ventilation Services
… Hospitals use International Classification of Diseases (ICD) procedure codes on their claims to report mechanical … ventilation services. When hospitals use a specific ICD procedure code to report a patient received 96 … for 4,874 inpatient APR-DRG claims that included an ICD procedure code for 96 consecutive hours or more of …
https://www.osc.ny.gov/state-agencies/audits/2019/05/16/medicaid-overpayments-inpatient-care-involving-mechanical-ventilation-servicesMedicaid Program – Medicaid Overpayments for Medicare Advantage Plan Services
… Purpose To determine if the Department of Health overpaid health care providers’ Medicaid claims for services also covered by Medicare Advantage plans. The … To determine if the Department of Health overpaid health care providers Medicaid claims for …
https://www.osc.ny.gov/state-agencies/audits/2018/12/11/medicaid-program-medicaid-overpayments-medicare-advantage-plan-servicesRestrictions on Consecutive Hours of Work for Nurses (Follow-Up)
… and agreed-upon hours. Employers are required to develop Nurse Coverage Plans to address typical patterns of … to guide its complaint investigations, resulting in missing documentation, inconsistent application of the Law, …
https://www.osc.ny.gov/state-agencies/audits/2019/09/09/restrictions-consecutive-hours-work-nurses-followImplementation of the Dignity for All Students Act (Follow-Up)
… Objective To determine the extent of implementation of the three … New York State’s Dignity for All Students Act (DASA) seeks to provide students in New York with a safe and supportive … race, sexual orientation, weight) and required schools to designate a trained Dignity Act Coordinator (DAC). An …
https://www.osc.ny.gov/state-agencies/audits/2019/11/21/implementation-dignity-all-students-act-followMedicaid Program – Improper Payments for Certain Third-Party Cost-Sharing Claims
… Objective To determine if Medicaid made overpayments to providers who reported claims with a PR 45 cost-sharing … To determine if Medicaid made overpayments to providers who reported claims with a PR 45 costsharing …
https://www.osc.ny.gov/state-agencies/audits/2025/11/05/medicaid-program-improper-payments-certain-third-party-cost-sharing-claimsTown of Somerset – Budgeting for Sales Tax (2016M-419)
… 2,600. The Town, which includes the Village of Barker within its borders, is governed by an elected …
https://www.osc.ny.gov/local-government/audits/town/2017/11/22/town-somerset-budgeting-sales-tax-2016m-419Brighter Choice Charter School for Boys - Payroll (2018M-139)
… Brighter Choice Charter School for Boys Payroll 2018M139 …
https://www.osc.ny.gov/local-government/audits/charter-school/2018/10/12/brighter-choice-charter-school-boys-payroll-2018m-139DiNapoli Calls for Transparency From Companies Regarding Affordability Concerns
… of our most intimate details — our identities, interests, locations, credit histories, medical conditions, sexual …
https://www.osc.ny.gov/press/releases/2026/03/dinapoli-calls-transparency-companies-regarding-affordability-concernsDiNapoli: State Needs to Improve Services for Vulnerable Adults
… protecting vulnerable adults to ensure they are handling cases properly, putting at-risk New Yorkers potentially in … abuse, neglect or financial exploitation. Many cases are not reported. Every month OCFS receives an average … 6 didn’t include the number of referrals that were ongoing cases. 3 didn’t include how many referrals were closed at …
https://www.osc.ny.gov/press/releases/2021/11/dinapoli-state-needs-improve-services-vulnerable-adultsMembership Milestones for Police & Fire Retirement System (PFRS) Members
… how your years of service affect your retirement benefits. For specific information about your retirement plan, go to … more years of service credit, you are: Eligible to apply for a non-job-related disability benefit. Eligible for an out-of-service death benefit, if you leave public …
https://www.osc.ny.gov/retirement/members/membership-milestones-police-fire-retirement-system-pfrs-membersRegulation for Scheduling, Adjourning and Conduct of Administrative Hearings
… §317.1 Background Whereas, Sections 74 and 374 of the Retirement and Social Security Law direct that the Comptroller, upon … of a written demand, shall hold a hearing to review and redetermine an application for retirement allowance or … Scheduling Adjourning and Conduct of Administrative Hearings …
https://www.osc.ny.gov/retirement/members/regulation-for-hearings