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Administration of Contract C007373 With the Institute for Community Living
… Purpose To determine whether the Office of Mental Health (OMH) is effectively administering its contract with the Institute for Community Living (ICL) by ensuring that contracted … To determine whether the Office of Mental Health OMH is effectively administering …
https://www.osc.ny.gov/state-agencies/audits/2016/12/30/administration-contract-c007373-institute-community-livingAdministration of the Contract With the Postgraduate Center for Mental Health
… Purpose To determine whether the Office of Mental Health (OMH) is effectively administering its Supportive Housing Contract … To determine whether the Office of Mental Health OMH is effectively administering its …
https://www.osc.ny.gov/state-agencies/audits/2016/12/30/administration-contract-postgraduate-center-mental-healthWestchester School for Special Children – Compliance With the Reimbursable Cost Manual
… the WSSC did not maintain the required vehicle logs or any other documentation to support the business use of the … the Executive Director spent $4,254 at a Harley Davidson dealer; $1,723 for lodging at the Majestic View Lodge near …
https://www.osc.ny.gov/state-agencies/audits/2013/07/02/westchester-school-special-children-compliance-reimbursable-cost-manualChildren’s Center for Early Learning – Compliance With the Reimbursable Cost Manual
… the Consolidated Fiscal Reports (CFRs) of the Children’s Center for Early Learning (Center) were calculated properly, documented adequately, and … from fiscal years 2005-06 and 2006-07. Background The Center provides special education services to New York … on the Consolidated Fiscal Reports CFRs of the Childrens Center for Early Learning Center were calculated proper …
https://www.osc.ny.gov/state-agencies/audits/2014/12/29/childrens-center-early-learning-compliance-reimbursable-cost-manualWhitestone School for Child Development – Compliance With the Reimbursable Cost Manual
… be disallowed. These ineligible costs included $115,296 in personal services costs and $39,267 in other than personal service costs. Among the disallowances we identified … the wrong fiscal year; and $3,088 for other miscellaneous personal and unsupported expenses. Key Recommendations To …
https://www.osc.ny.gov/state-agencies/audits/2015/04/07/whitestone-school-child-development-compliance-reimbursable-cost-manualUnited HealthCare – Overpayments for Services Provided by Long Island Spine Specialists
… Purpose To determine whether Long Island Spine Specialists, P.C. waived Empire Plan members’ out-of-pocket … focused on claims submitted to United by Long Island Spine Specialists, P.C. (Long Island Spine), a non-participating … To determine whether Long Island Spine Specialists PC waived Empire Plan members outofpocket costs …
https://www.osc.ny.gov/state-agencies/audits/2016/05/05/united-healthcare-overpayments-services-provided-long-island-spine-specialistsMedicaid Program – Managed Care Organizations’ Readiness for the Encounter Intake System
… of the readiness of Medicaid MCOs as of September 30, 2015. We did not review the adequacy of the Department’s … covers the period January 1, 2014 through September 30, 2015. Background MCOs are contractually required to submit … setting, and drug rebate collections. On September 14, 2015, the Department's new Encounter Intake System (EIS) …
https://www.osc.ny.gov/state-agencies/audits/2016/03/29/medicaid-program-managed-care-organizations-readiness-encounter-intake-systemMonitoring of Medicaid Payments for Nursing Home Bed Reserve Days (Follow-Up)
… report, Monitoring of Medicaid Payments for Nursing Home Bed Reserve Days (Report 2010-S-21). Background Our initial … nursing home claims submitted to Medicaid for hospital bed reserve days were appropriate, and if not, to what extent nursing home claims exceeded the bed reserve day limits. During the five year audit period …
https://www.osc.ny.gov/state-agencies/audits/2013/01/10/monitoring-medicaid-payments-nursing-home-bed-reserve-days-followExcessive Medicaid Payments for Services to Recipients Receiving Medicare Benefits (Follow-Up)
… Medicaid Payments for Services to Recipients Receiving Medicare Benefits (Report 2009-S-64). Background Our initial … Medicaid recipients who also have health insurance through Medicare. During the four year audit period ended June 30, … to limit Medicaid payments in areas where Medicaid and Medicare programs overlap. The remaining $100 million in …
https://www.osc.ny.gov/state-agencies/audits/2013/04/26/excessive-medicaid-payments-services-recipients-receiving-medicare-benefits-followUnited HealthCare – Overpayments for Services Provided by Long Island Laparoscopic Surgery
… March 31, 2015. Background The New York State Health Insurance Program (NYSHIP) provides health insurance coverage to active and retired State, participating … will result in United making an excessive payment on the claim. Our audit focused on claims submitted to United by …
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
… Purpose To determine whether the costs reported by Astor Services for Children & Families (Astor) on its Consolidated … To determine whether the costs reported by Astor Services for Children Families Astor on its Consolidated …
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)
… care needs. The New York State Controlled Substances Act (Act) was enacted to combat the illegal use of controlled substances. The Act limits the 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 ). … Medicaid inappropriately paid 29,289 fee-for-services pharmacy claims totaling $978,251 on behalf of 18,010 Medicaid recipients whose pharmacy benefits were covered by managed care. We …
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
… Special Education Itinerant Teacher (SEIT) and Special Class Integrated Setting (SCIS) programs to disabled children … 942 students. The New York City Department of Education (DoE) refers students to Starting Point based on clinical … the three fiscal years ended June 30, 2013, we identified $2,585,454 in reported costs that did not comply with Manual …
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
… to August 31, 2013. Background The New York State Health Insurance Program (NYSHIP) provides health insurance coverage to more than 1.2 million active and retired State, … 59 may involve a different anatomical site or separate injury. From September 1, 2012 to August 31, 2013, United …
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
… the State Education Department’s (SED) Reimbursable Cost Manual (Manual). The audit included all expenses claimed on … $801,859 in reported costs that did not comply with Manual requirements and recommend such costs be disallowed. …
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
… with corresponding payments totaling about $193 million. One of the largest such contracts DOHMH awarded was with … costs. Agency Response In their responses to our draft audit report, DOHMH and CUCS disagreed with our …
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
… hospitals by reimbursing for higher levels of medical care than those actually provided to patients. The audit … Medicaid recipients in need of inpatient hospital care are provided a full range of necessary diagnostic, palliative and therapeutic care, including but not limited to surgical, medical, …
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
… ended June 30, 2010. Background All Services, located in Fresh Meadows, New York, provided special education itinerant …
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
… to ensure accurate eligibility determinations and timely closure of Buy-in Program cases for ineligible individuals. …
https://www.osc.ny.gov/state-agencies/audits/2021/11/29/medicaid-program-improper-payments-medicare-buy-premiums-ineligible-recipients