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Medicaid Program – Maximizing Drug Rebates for Health and Recovery Plans
… of Health took appropriate steps to collect all available drug rebates for Health and Recovery Plans. The audit covered … 2017. Background In 1990, Congress created the Medicaid Drug Rebate Program to reduce state and federal expenditures for Medicaid prescription drug costs. In January 1991, New York’s Medicaid program …
https://www.osc.ny.gov/state-agencies/audits/2018/06/22/medicaid-program-maximizing-drug-rebates-health-and-recovery-plansPrograms for Little Learners – Compliance With the Reimbursable Cost Manual
… special education services through rates set by SED. The reimbursement rates are based on financial information, … PFLL reports to SED on its annual CFR. To be eligible for reimbursement, reported costs must comply with RCM … to the costs reported on PFLL’s CFRs and to PFLL’s tuition reimbursement rates. Remind PFLL officials of the pertinent …
https://www.osc.ny.gov/state-agencies/audits/2018/09/24/programs-little-learners-compliance-reimbursable-cost-manualYork College – Time and Attendance Practices for Public Safety Staff
… Purpose To determine whether York College had adequate controls over the time and attendance of … and other activities at the individual colleges. Each college is responsible for complying with governing laws, regulations, policies, and guidelines. York College (York) is a senior CUNY college located in Jamaica, …
https://www.osc.ny.gov/state-agencies/audits/2015/04/06/york-college-time-and-attendance-practices-public-safety-staffOverpayments of Hospitals’ Claims for Lengthy Acute Care Admissions (Follow-Up)
… Overpayments of Hospitals’ Claims for Lengthy Acute Care Admissions (2010-S-30). Background Medicaid is a … program that provides a wide range of health care services to those who are economically disadvantaged and/or have special health care needs. When billing Medicaid for inpatient services, …
https://www.osc.ny.gov/state-agencies/audits/2015/07/07/overpayments-hospitals-claims-lengthy-acute-care-admissions-followUnited HealthCare – Overpayments for Services Provided by Dr. John Gomes
… costs, and if so, to quantify the overpayments made by United HealthCare (United) resulting from this practice. … who agree to accept payments, at rates established by United, to furnish medical services to Empire Plan … from patients. Our audit focused on claims submitted by Women’s Healthcare - Garden City, an obstetrics and …
https://www.osc.ny.gov/state-agencies/audits/2016/05/05/united-healthcare-overpayments-services-provided-dr-john-gomesLeague for the Handicapped – Compliance With the Reimbursable Cost Manual
… Purpose To determine whether the costs reported by the League for the Handicapped (LFH) on its Consolidated Fiscal Report … To determine whether the costs reported by the League for the Handicapped LFH on its Consolidated Fiscal Report CFR …
https://www.osc.ny.gov/state-agencies/audits/2016/06/03/league-handicapped-compliance-reimbursable-cost-manualCrossroads Center for Children – Compliance With the Reimbursable Cost Manual
… to children with disabilities who are between the ages of three and five years. Crossroads is reimbursed for … tuition reimbursement rates. Remind Crossroads officials of the pertinent SED guidelines that relate to the … clarification as needed. Other Related Audits/Reports of Interest State Education Department: Newmeadow, Inc. – …
https://www.osc.ny.gov/state-agencies/audits/2016/05/13/crossroads-center-children-compliance-reimbursable-cost-manualCenter for Disability Services – Compliance With the Reimbursable Cost Manual
… To determine whether the costs reported by the Center for Disability Services (CFDS) on its Consolidated Fiscal … December 31, 2013. Background CFDS is an SED-approved not-for-profit special education provider located in Albany, New … the ages of three and five years. CFDS is reimbursed for preschool special education program services through …
https://www.osc.ny.gov/state-agencies/audits/2016/05/13/center-disability-services-compliance-reimbursable-cost-manualUnnecessary Managed Care Payments for Medicaid Recipients With Medicare (Follow-Up)
… audit report, Unnecessary Managed Care Payments for Medicaid Recipients With Medicare (Report 2010-S-75). … Department of Health (Department) made premium payments to Medicaid managed care plans for Medicaid recipients who also had Medicare health insurance … initial audit report Unnecessary Managed Care Payments for Medicaid Recipi …
https://www.osc.ny.gov/state-agencies/audits/2013/11/01/unnecessary-managed-care-payments-medicaid-recipients-medicare-followAnnual Assessment of Market Orders for 2012, 2013, and 2014
… has adequate procedures in place to accurately report its assessable expenses related to its administration … Follow up on the questionable expenses identified in our report and seek repayment for any inappropriate or ineligible … source justification requirements. Other Related Audit/Report of Interest Department of Agriculture and Markets: …
https://www.osc.ny.gov/state-agencies/audits/2015/05/07/annual-assessment-market-orders-2012-2013-and-2014Medicaid Program – Overpayments for Services Also Covered by Medicare Part B
… consists of several parts. Medicare Part B helps pay for medical care provided in outpatient settings. Medicaid is a … provided in outpatient settings such as doctors' offices, clinics, and health centers. Some heath centers are federally …
https://www.osc.ny.gov/state-agencies/audits/2013/07/09/medicaid-program-overpayments-services-also-covered-medicare-part-bMedicaid Program – Improper Managed Care Payments for Misclassified Patient Discharges
… to reimburse hospitals for inpatient medical care. When a hospital bills an MCO for an inpatient stay, the hospital reports certain information on its claims, such as … than if the patient was simply discharged home from the hospital. Key Findings The audit identified 2,808 managed …
https://www.osc.ny.gov/state-agencies/audits/2022/08/19/medicaid-program-improper-managed-care-payments-misclassified-patient-dischargesCompliance With Special Education Regulations for the Provision of Services
… who were initially referred during the 2016-17 school year. About the Program Special education services and … the Regulations require that DOE arrange for the placement of eligible students in special education services … of parental consent to evaluate. However, arranging placement is not the end of the process as it is more …
https://www.osc.ny.gov/state-agencies/audits/2020/09/30/compliance-special-education-regulations-provision-servicesImproper Fee-for-Service Payments for Services Covered by Managed Care (Follow-Up)
… Improper Fee-for-Service Payments for Services Covered by Managed Care (Report 2017-S-74 ). About the Program The … made improper FFS payments for certain services covered by Plans. The audit covered the period January 1, 2013 … FFS payments for services that should have been covered by the recipients’ Plans. We determined the majority of the …
https://www.osc.ny.gov/state-agencies/audits/2021/02/11/improper-fee-service-payments-services-covered-managed-care-followSelected Aspects of Collecting Outstanding Amounts Due for Parking Violations
… for parking, red light camera, bus lane camera, and school zone camera violations. DOF’s responsibilities include … all amounts due from summonses that are in judgment (i.e., a vehicle owner has failed to pay the fine, plead not guilty within the time allowed, or appear for a hearing). The Collection Division includes the Parking and …
https://www.osc.ny.gov/state-agencies/audits/2021/03/23/selected-aspects-collecting-outstanding-amounts-due-parking-violationsImproper Medicaid Payments for Recipients Diagnosed With Severe Malnutrition (Follow-Up)
… the appropriate International Classification of Diseases (ICD) code on its Medicaid claim to reflect the diagnosis. …
https://www.osc.ny.gov/state-agencies/audits/2020/09/02/improper-medicaid-payments-recipients-diagnosed-severe-malnutrition-followMedicaid Overpayments for Inpatient Care Involving Mechanical Ventilation Services (Follow-Up)
… 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 consecutive hours or …
https://www.osc.ny.gov/state-agencies/audits/2020/09/15/medicaid-overpayments-inpatient-care-involving-mechanical-ventilation-services-followEmblemHealth Plan, Inc.: Overpayments for Services Requiring Coordination of Benefits
To determine whether EmblemHealth Plan Inc overpaid dental claims for members covered by two subscriber plans under the New York State Dental Insurance Program
https://www.osc.ny.gov/state-agencies/audits/2024/01/08/emblemhealth-plan-inc-overpayments-services-requiring-coordination-benefitsApplication Review and Site Permitting for Major Renewable Energy Projects
… its obligations under State law to issue siting permits for major renewable energy projects within the required time … goals of the Climate Act strive to improve quality of life for New Yorkers, protect the environment, and strengthen … allowed to transfer their project applications to ORES for review. ORES has 60 days to determine whether a permit …
https://www.osc.ny.gov/state-agencies/audits/2024/04/24/application-review-and-site-permitting-major-renewable-energy-projectsCantalician Center for Learning – Compliance With the Reimbursable Cost Manual
… to children with disabilities who are between the ages of 3 and 5 years. Cantalician is reimbursed for these … education programs that it operated: Preschool Special Class – over 2.5 hours per day and Preschool Integrated Special Class – over 2.5 hours per day (collectively referred to as …
https://www.osc.ny.gov/state-agencies/audits/2023/01/26/cantalician-center-learning-compliance-reimbursable-cost-manual