Search
Astor Services for Children & Families – Compliance With the Reimbursable Cost Manual
… services to children with disabilities between the ages of three and five years. Astor is reimbursed for preschool … CFR, of which $3.3 million was for the Preschool Special Class and the Preschool Integrated Special Class (Programs) we audited. Key Findings We identified …
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)
… Improper Fee-for-Service Payments for Pharmacy Services Covered by Managed Care (Report 2014-S-5 ). Background Our initial … of 18,010 Medicaid recipients whose pharmacy benefits were covered by managed care. We recommended the Department review …
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
… To determine whether UnitedHealthcare improperly paid for medical services designated with modifier code 59 that were … with UnitedHealthcare (United) to process and pay medical and surgical claims for services provided to Empire Plan members. United’s payments to medical providers are based, in part, on procedure codes …
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
… 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 Milestone School for Child Development … between the ages of three and five years. During the 2012-13 school year, Milestone serviced about 110 students. …
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
… Also, with their response, CUCS officials provided an addendum, which includes examples of methodologies they … of costs to report on their QFRs, and consequently, the addendum’s analysis does not correspond with or support the …
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 … Medicaid for inpatient services, hospitals must indicate a patient's level of care on a claim to ensure accurate …
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
… To determine whether the costs reported by All Services for Kids, Inc. (All Services) on its Consolidated Fiscal … To determine whether the costs reported by All Services for Kids Inc All Services on its Consolidated Fiscal Reports …
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
… recoverable. Medicaid paid $23.6 million in premiums for 3,439 individuals who were automatically added to the Buy-in … Follow up with CMS to request payment relief on the 3,439 cases where recipients were added to the Buy-in 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 concluded that the State’s Medicaid program paid $20.1 million for services that, according to the claims data, …
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
… To determine whether Empire BlueCross properly paid hospital claims for intraocular procedures. The audit covered … million members. Empire BlueCross (Empire) administers the hospital portion of the Empire Plan. Empire processes claims for hospital services according to contracts it negotiates with …
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)
… HMS enters into data-sharing agreements with third-party insurers to obtain this information. The Department, Local … with HMS to amend data-sharing agreements with third-party insurers to require more frequent TPHI updates; work with …
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)
… Recipients in an Opioid Treatment Program (Report 2017-S-66 ). About the Program Opioid treatment programs (Treatment …
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)
… provides supplemental insurance coverage for outpatient medical services, physician services, and medical supplies. As the secondary payer, Medicaid generally …
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
… whether Medicaid inappropriately paid for drugs from manufacturers that did not enter into a national drug rebate … dispensed to Medicaid patients. The MDRP requires drug manufacturers to enter into an NDRA with the Department of … Medicaid coverage of most of the manufacturer’s drugs. Manufacturers then pay states rebates on those drugs for …
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)
… to approximately 192,000 of these students in the 2021-22 school year. The DOE is responsible for evaluating …
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
… the appropriate International Classification of Diseases (ICD) code on its claim to reflect the diagnosis. Generally, …
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
… established in 1946 and was reapproved by SED on July 1, 2012 to operate full-day Preschool Special Class (SC) and …
https://www.osc.ny.gov/state-agencies/audits/2019/01/11/northside-center-child-development-compliance-reimbursable-cost-manualMedicaid Program – Improper Fee-for-Service Payments for Services Covered by Managed Care
… ranging from hospital inpatient care to physician and dental services. Accordingly, Plans are responsible for … in improper FFS payments for inpatient, practitioner, and dental services that should have been covered by Plans. Many …
https://www.osc.ny.gov/state-agencies/audits/2019/01/10/medicaid-program-improper-fee-service-payments-services-covered-managed-care