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Whitestone School for Child Development – Compliance With the Reimbursable Cost Manual
… determine whether the costs reported on the Consolidated Fiscal Reports (CFRs) of the Whitestone School for Child … (Manual). The audit included all expenses claimed for the fiscal year 2012-13 and certain expenses for the two fiscal years ended June 30, 2012. Background Whitestone is a …
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. … 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-spine-specialistsMedicaid Program – Managed Care Organizations’ Readiness for the Encounter Intake System
… data submissions. The audit covers the period January 1, 2014 through September 30, 2015. Background MCOs are …
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)
… initial audit report, Monitoring of Medicaid Payments for Nursing Home Bed Reserve Days (Report 2010-S-21). Background … which was issued on December 9, 2010, examined whether 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. …
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)
… this amount occurred because the Department did not ensure New York’s regulatory structure has kept pace with other states’ …
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
… 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
… Background Astor, a not-for-profit organization located in Rhinebeck, New York, provides preschool special education … reported costs must comply with the guidelines specified in the RCM. For the fiscal year ended June 30, 2013, Astor reported a total of $6.4 million in reimbursable costs on its CFR, of which $3.3 million was …
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)
… in which quantities of controlled substances exceeded the supply limits allowed by the Act. We further identified 3,323 … from pharmacies for controlled substances that exceeded supply limits allowed by the Act. We recommended that the … for quantities of controlled substances that exceeded supply limits allowed by the Act. These actions resulted in …
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
… 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
… whether the costs reported by the Milestone School for Child Development (Milestone) on its Consolidated Fiscal … The audit included all expenses claimed on Milestone’s CFR for the fiscal year 2012-13, and certain expenses claimed on Milestone’s CFRs for the two fiscal years ended June 30, 2012. Background The …
https://www.osc.ny.gov/state-agencies/audits/2015/07/17/milestone-school-child-development-compliance-reimbursable-cost-manualMedicaid Overpayments for Inpatient Transfer Claims Among Merged or Consolidated Facilities
… two separate payments are made: a payment for the first hospital’s claim and a payment for the second hospital’s claim. However, according to the Department’s … when a recipient is transferred from the first hospital to a merged or consolidated division or hospital, …
https://www.osc.ny.gov/state-agencies/audits/2015/12/08/medicaid-overpayments-inpatient-transfer-claims-among-merged-or-consolidated-facilitiesMedicaid 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
… if Medicaid made improper Medicare premium payments on behalf of recipients enrolled in the Medicare buy-in program. The audit covered Medicaid … should not pay premiums for Buy-in Program coverage on behalf of individuals who do not have a benefit … if Medicaid made improper Medicare premium payments on behalf of recipients enrolled in the Medicare buyin program …
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)
… audit report, Overpayments for Therapy Services and Prescription Drugs Covered by Medicare (Report 2016-S-73 ). … occupational, and speech therapy services as well as prescription drugs. When these services are rendered to … care providers’ Medicaid claims for therapy services and prescription drugs that are covered by Medicare. The audit …
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)
… – auditors noted 493 of the 18,786 recipients required medical care as a result of opioid or narcotic overdoses that … and 12 of those individuals died during the time of their medical care involving the overdose. Based on a review of medical records for a sample of 25 recipients who received …
https://www.osc.ny.gov/state-agencies/audits/2020/05/07/opioid-prescriptions-medicaid-recipients-opioid-treatment-program-follow