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Poland Central School District - Claims Audit Process (2018M-214)
Determine whether claims were supported by adequate documentation, for appropriate purposes and audited and approved before payment.
https://www.osc.ny.gov/files/local-government/audits/pdf/poland.pdfUnitedHealthcare: Out-of-Network Providers Upcoding Selected Evaluation and Management Services (2017-S-34)
To determine whether UnitedHealthcare sufficiently monitors out-of-network providers who routinely bill for higher-level Evaluation and Management services ...
https://www.osc.ny.gov/files/state-agencies/audits/pdf/sga-2019-17s34.pdfVillage of Lyons Falls - Board Oversight (2018M-174)
Determine whether the Board provided adequate oversight to ensure Village funds are properly accounted for and safeguarded.
https://www.osc.ny.gov/files/local-government/audits/pdf/lyons-falls.pdfRecord of Activities Sample
An example record of activities (ROA) for NYSLRS employers and their elected and appointment officials to reference.
https://www.osc.ny.gov/files/retirement/members/pdf/record-of-activities-sample.pdfOversight of Clinical Trials (2024-S-22)
To determine whether DOH has provided adequate oversight of services for Medicaid members enrolled in clinical trials.
https://www.osc.ny.gov/files/state-agencies/audits/pdf/sga-2026-24s22.pdfCVS Caremark Payments Made Under the Incorrect Plan
To determine whether CVS Caremark paid pharmacy claims under the appropriate plan for Medicare-qualified Empire Plan members.
https://www.osc.ny.gov/files/state-agencies/audits/pdf/sga-2026-25s19.pdfImproper Medicaid Payments for Claims Not in Compliance With Ordering, Prescribing, Referring, and Attending Requirements (Follow-Up) (2023-F-3) 30-Day Response
To assess the extent of implementation of the 12 recommendations included in our initial audit report, Improper Medicaid Payments for Claims Not in Compliance With Ordering, Prescribing, Referring, and Attending Requirements (Report 2019-S-2).
https://www.osc.ny.gov/files/state-agencies/audits/pdf/sga-2023-23f4-response.pdfAssessment of Costs to Administer the Workers’ Compensation Program for the Three State Fiscal Years Ended March 31, 2023 (2024-M-1)
To ascertain the total expenses that the Workers’ Compensation Board (Board) incurred in administering the Workers’ Compensation Program for the 3 State Fiscal Years ended March 31, 2023.
https://www.osc.ny.gov/files/state-agencies/audits/pdf/sga-2025-24m1.pdfAssessment of Costs to Administer the Workers' Compensation Program for the Three State Fiscal Years Ended March 31, 2020 (2021-M-1)
To ascertain the total expenses that the Workers’ Compensation Board incurred in administering the Workers’ Compensation Program for the three State Fiscal Years ended March 31, 2020.
https://www.osc.ny.gov/files/state-agencies/audits/pdf/sga-2021-21m1.pdfEye Care Provider and Family Inappropriately Enroll as Recipients and Overcharge for Vision Services (Follow-Up) (2017-F-11) 30-Day Response
To determine the implementation status of the eight recommendations in our initial audit report, Eye Care Provider and Family Inappropriately Enroll as Recipients and Overcharge for Vision Services (Report 2013-S-1) ...
https://www.osc.ny.gov/files/state-agencies/audits/pdf/sga-2017-17f11-response.pdfAmbulatory Patient Groups Payments for Duplicate Claims and Services in Excess of Medicaid Service Limits (Follow-Up) (2017-F-3) 30-Day Response
To determine the implementation status of the six recommendations made in our initial audit report, Ambulatory Patient Groups Payments for Duplicate Claims and Services in Excess of Medicaid Service Limits (Report 2013-S-17).
https://www.osc.ny.gov/files/state-agencies/audits/pdf/sga-2017-17f3-response.pdfEmpire BlueCross – Improper Payments for Special Items Billed by Hospitals Within Long Island Health Network (2017-S-43) 180-Day Response
To determine whether Empire BlueCross paid claims for special items according to the terms of its contract with Long Island Health Network and, if not ...
https://www.osc.ny.gov/files/state-agencies/audits/pdf/sga-2019-17s43-response.pdfElection Form for Coverage Under Article 22 (Tier 5) in Accordance with Chapter 263 of the Laws of 2016 (RS5536)
To elect coverage under Article 22 (Tier 5), PFRS Tier 3 members use form RS5536.
https://www.osc.ny.gov/files/retirement/forms/pdf/rs5536.pdfSelected Payments for Special Items Made to Stony Brook University Hospital from January 1, 2011 through March 31, 2011 (2012-S-53)
We audited selected claim payments made by Empire BlueCross BlueShield (Empire) to the State University of New York’s Stony Brook University Hospital (Stony Bro
https://www.osc.ny.gov/files/state-agencies/audits/pdf/sga-2012-12s53.pdfUnder Reporting of Net Available Monthly Income for Nursing Home Residents Causes Medicaid Overpayments (Follow-Up) (2013-F-11), 30-Day Response
We have followed up on the actions taken by officials of the Department of Health (Department) to implement the recommendations contained in our audit report,
https://www.osc.ny.gov/files/state-agencies/audits/pdf/sga-2013-13f11-response.pdfSelected Payments for Special Items Made to Mary Imogene Bassett Hospital from January 1, 2011 through March 31, 2011 (2012-S-61)
This report is part of a series of audits of Empire’s payments to selected hospitals for “special items” during the three months ended March 31, 2011.
https://www.osc.ny.gov/files/state-agencies/audits/pdf/sga-2012-12s61.pdfSelected Payments for Special Items Made to Mount Sinai Medical Center from January 1, 2011 through March 31, 2011 (2012-S-60)
This report is part of a series of audits of Empire’s payments to selected hospitals for “special items” during the three months ended March 31, 2011.
https://www.osc.ny.gov/files/state-agencies/audits/pdf/SGA-2012-12s60.pdfSelected Payments for Special Items Made to Albany Medical Center Hospital from January 1, 2011 through March 31, 2011 (2012-S-59)
This report is part of a series of audits of Empire’s payments to selected hospitals for “special items” during the three months ended March 31, 2011.
https://www.osc.ny.gov/files/state-agencies/audits/pdf/sga-2012-12s59.pdfThe Network for Children’s Speech, Occupational & Physical Therapy, LLC - Compliance With the Reimbursable Cost Manual (2017-S-79) 90-Day Response
To determine whether the costs reported by The Network for Children’s Speech, Occupational & Physical Therapy, LLC on its Consolidated Fiscal Reports ...
https://www.osc.ny.gov/files/state-agencies/audits/pdf/sga-2018-17s78-response_1.pdfAssessment of Costs to Administer the Workers’ Compensation Program for the Three Fiscal Years Ended March 31, 2017 (2017-S-64)
To assess the accuracy of the Workers’ Compensation Board’s reported assessable expenses and compliance with relevant statutes related to...
https://www.osc.ny.gov/files/state-agencies/audits/pdf/sga-2018-17s64.pdf