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United HealthCare – Overpayments for Services Provided by Long Island Laparoscopic Surgery
… Purpose To determine whether Long Island Laparoscopic Surgery, PLLC … Empire Plan members’ out-of-pocket costs, and if so, to quantify the overpayments made by United HealthCare … Program (NYSHIP) provides health insurance coverage to active and retired State, participating local government, …
https://www.osc.ny.gov/state-agencies/audits/2016/05/05/united-healthcare-overpayments-services-provided-long-island-laparoscopic-surgeryAstor Services for Children & Families – Compliance With the Reimbursable Cost Manual
… for Children & Families (Astor) on its Consolidated Fiscal Report (CFR) were properly calculated, adequately documented … for Children Families Astor on its Consolidated Fiscal Report CFR were properly calculated adeq …
https://www.osc.ny.gov/state-agencies/audits/2015/09/02/astor-services-children-families-compliance-reimbursable-cost-manualImproper Payments for Controlled Substances That Exceed Allowed Dispensing Limits (Follow-Up)
… Medicaid program provides a wide range of health care services, including prescription drugs, to individuals who … We recommended that the Department review the improper pharmacy claims we identified and make recoveries. We also … included implementing controls to prevent the payment of pharmacy claims for quantities of controlled substances that …
https://www.osc.ny.gov/state-agencies/audits/2016/09/23/improper-payments-controlled-substances-exceed-allowed-dispensing-limits-followImproper Fee-for-Service Payments for Pharmacy Services Covered by Managed Care (Follow-Up)
… audit report, Improper Fee-for-Service Payments for Pharmacy Services Covered by Managed Care (Report 2014-S-5 ). … Program - Improper Fee-for-Service Payments for Pharmacy Services Covered by Managed Care (2014-S-5) … initial audit report Improper FeeforService Payments for Pharmacy Services …
https://www.osc.ny.gov/state-agencies/audits/2016/09/23/improper-fee-service-payments-pharmacy-services-covered-managed-care-followStarting Point Services for Children – Compliance With the Reimbursable Cost Manual
… Purpose To determine whether the costs reported by Starting Point Services for Children (Starting Point) on its Consolidated Fiscal Reports (CFRs) were … The audit included all expenses claimed on Starting Point’s CFR for the fiscal year ended June 30, 2013, and …
https://www.osc.ny.gov/state-agencies/audits/2015/12/11/starting-point-services-children-compliance-reimbursable-cost-manualUnitedHealthcare – Improper Payments for Medical Services Designated By Modifier Code 59
… September 1, 2012 to August 31, 2013, United paid over $82.3 million for about 1.3 million services with modifier 59. …
https://www.osc.ny.gov/state-agencies/audits/2015/01/08/unitedhealthcare-improper-payments-medical-services-designated-modifier-code-59Milestone School for Child Development – Compliance With the Reimbursable Cost Manual
Determine whether the costs reported by Milestone School for Child Development on its CFRs were properly documented program related allowable pursuant to SED
https://www.osc.ny.gov/state-agencies/audits/2015/07/17/milestone-school-child-development-compliance-reimbursable-cost-manualAdministration of the Contract With the Center for Urban Community Services
… (DOHMH) administration of a contract (#113 225 01) with the Center for Urban Community Services (CUCS) for the … appropriate contract expenses. Background DOHMH contracts with not-for-profit providers for a range of health and … had 164 active contracts for supportive housing programs with corresponding payments totaling about $193 million. One …
https://www.osc.ny.gov/state-agencies/audits/2016/02/16/administration-contract-center-urban-community-servicesMedicaid Program – Overpayments of Hospitals' Claims for Lengthy Acute Care Admissions
… 2010. Background Medicaid recipients in need of inpatient hospital care are provided a full range of necessary diagnostic, palliative and … Department and IPRO to review a judgmental sample of 297 hospital stays that were billed by ten hospitals for patients …
https://www.osc.ny.gov/state-agencies/audits/2013/07/25/medicaid-program-overpayments-hospitals-claims-lengthy-acute-care-admissionsAll Services for Kids, Inc. – Compliance With the Reimbursable Cost Manual
… Fiscal Reports CFRs are adequately documented and al …
https://www.osc.ny.gov/state-agencies/audits/2014/02/25/all-services-kids-inc-compliance-reimbursable-cost-manualMedicaid Program – Improper Payments of Medicare Buy-in Premiums for Ineligible Recipients
… Objective To determine if Medicaid made improper Medicare premium payments on behalf of recipients enrolled in the Medicare buy-in program. The audit covered Medicaid payments for individuals enrolled in the Medicare buy-in program for the period from January 1, 2015 …
https://www.osc.ny.gov/state-agencies/audits/2021/11/29/medicaid-program-improper-payments-medicare-buy-premiums-ineligible-recipientsOverpayments for Therapy Services and Prescription Drugs Covered by Medicare (Follow-Up)
… included in our initial audit report, Overpayments for Therapy Services and Prescription Drugs Covered by Medicare … Medicare program covers physical, occupational, and speech therapy services as well as prescription drugs. When these … overpaid health care providers’ Medicaid claims for therapy services and prescription drugs that are covered by …
https://www.osc.ny.gov/state-agencies/audits/2021/11/29/overpayments-therapy-services-and-prescription-drugs-covered-medicare-followEmpire BlueCross – Improper Payments for Intraocular Lens Claims Billed by Hospitals
… The audit covered the period January 1, 2014 through June 30, 2019. About the Program The New York State Health … used in the treatment of cataracts – the clouding of the lens in the eye – which cause vision problems. A cataract is … appropriate payments. From January 1, 2014 through June 30, 2019, Empire paid over $1.5 million for 3,169 special …
https://www.osc.ny.gov/state-agencies/audits/2019/12/20/empire-bluecross-improper-payments-intraocular-lens-claims-billed-hospitalsManaged Care Premium Payments for Recipients With Comprehensive Third-Party Insurance (Follow-Up)
… report, Managed Care Premium Payments for Recipients With Comprehensive Third-Party Insurance (Report … Office of the Medicaid Inspector General (OMIG) contracts with Health Management Systems, Incorporated (HMS) to … coverages. HMS enters into data-sharing agreements with third-party insurers to obtain this information. The …
https://www.osc.ny.gov/state-agencies/audits/2020/01/17/managed-care-premium-payments-recipients-comprehensive-third-party-insurance-followOpioid Prescriptions for Medicaid Recipients in an Opioid Treatment Program (Follow-Up)
… a prescription opioid, and 12 of those individuals died during the time of their medical care involving the …
https://www.osc.ny.gov/state-agencies/audits/2020/05/07/opioid-prescriptions-medicaid-recipients-opioid-treatment-program-followMedicaid Overpayments for Medicare Part B Services Billed Directly to eMedNY (Follow-Up)
… also enrolled in Medicare Part B (Part B), which provides supplemental insurance coverage for outpatient medical …
https://www.osc.ny.gov/state-agencies/audits/2020/07/01/medicaid-overpayments-medicare-part-b-services-billed-directly-emedny-followMedicaid Program – Improper Payments for Drugs Without a Federal Drug Rebate Agreement
… without an NDRA, and determine the appropriate course of action to maximize recoveries. Review the …
https://www.osc.ny.gov/state-agencies/audits/2024/02/23/medicaid-program-improper-payments-drugs-without-federal-drug-rebate-agreementCompliance With Special Education Regulations for the Provision of Services (Follow-Up)
… education. The New York City Department of Education (DOE) – the nation’s largest school system – served … 192,000 of these students in the 2021-22 school year. The DOE is responsible for evaluating students to determine their … receive appropriate services. Toward this end, the DOE follows a multi-step evaluation and placement process. …
https://www.osc.ny.gov/state-agencies/audits/2023/03/15/compliance-special-education-regulations-provision-services-followMedicaid Program – Improper Medicaid Payments for Recipients Diagnosed With Severe Malnutrition
… covered the period from January 1, 2013 through December 31, 2017. Background Malnutrition can result from the general … the appropriate International Classification of Diseases (ICD) code on its claim to reflect the diagnosis. Generally, … practice. For the five-year period ended December 31, 2017, Medicaid paid about $521 million for inpatient …
https://www.osc.ny.gov/state-agencies/audits/2019/04/08/medicaid-program-improper-medicaid-payments-recipients-diagnosed-severe-malnutritionNorthside Center for Child Development – Compliance With the Reimbursable Cost Manual
… ended June 30, 2014. Background Northside was established in 1946 and was reapproved by SED on July 1, 2012 to operate … Special Class (SC) and full-day Preschool Special Class in an Integrated Setting (SCIS) to children with disabilities … 65 to 75 students from nine different school districts in its cost-based programs. Northside is reimbursed for …
https://www.osc.ny.gov/state-agencies/audits/2019/01/11/northside-center-child-development-compliance-reimbursable-cost-manual