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Astor Services for Children & Families – Compliance With the Reimbursable Cost Manual
… To determine whether the costs reported by Astor Services for Children & Families (Astor) on its Consolidated Fiscal … fiscal year ended June 30, 2013. Background Astor, a not-for-profit organization located in Rhinebeck, New York, … the ages of three and five years. Astor is reimbursed for preschool special education services through rates set by …
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)
… dispense when prescriptions are ordered by telephone or fax. Our initial audit report, which was issued on February … 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)
… Purpose To determine the extent of implementation of the three recommendations included in our initial audit … To determine the extent of implementation of the three recommendations included in …
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 … documented, program related, and allowable pursuant to the State Education Department’s (SED) Reimbursable Cost … Determine whether the costs reported by Starting Point Services for Children on …
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
… Purpose To determine whether the costs reported by the Milestone School for Child Development (Milestone) on its Consolidated Fiscal … Determine whether the costs reported by Milestone School for Child Development on its CFRs were properly documented …
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
… CUCS receives additional funding from the New York City HIV and AIDS Services Administration and the Department of Homeless …
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
… whether Medicaid overpaid hospitals by reimbursing for higher levels of medical care than those actually provided to patients. The audit … rehabilitative and psychiatric care. When billing Medicaid for inpatient services, hospitals must indicate a patient's …
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 Reports CFRs …
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)
… The Medicare program covers physical, occupational, and speech therapy services as well as prescription drugs. When … included $18.6 million for physical, occupational, and speech therapy services and $1.5 million for prescription …
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
… properly paid hospital claims for intraocular procedures. The audit covered the period January 1, 2014 through June 30, … of the lens in the eye – which cause vision problems. A cataract is corrected with surgery, which frequently involves removing the clouded lens …
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)
… Departments of Social Services (LDSS), and the New York State of Health are responsible for identifying enrollees … them from managed care. We issued our initial audit report on June 13, 2018. The audit objective was to determine … made Medicaid mainstream managed care premium payments on behalf of recipients who had comprehensive TPHI coverage. …
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)
… Objective To determine the extent of implementation of the three recommendations included in our initial audit report, Opioid Prescriptions for Medicaid Recipients in an Opioid Treatment Program … To determine the extent of implementation of the three recommendations …
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)
… Objective To determine the extent of implementation of the five … Overpayments for Medicare Part B Services Billed Directly to eMedNY (Report 2017-S-36 ). About the Program The … To determine the extent of implementation of the five …
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
… To determine whether Medicaid inappropriately paid for drugs from manufacturers that did not enter into a … the Department of Health and Human Services in exchange for state Medicaid coverage of most of the manufacturer’s … Manufacturers then pay states rebates on those drugs for which Medicaid payments were made. Covered outpatient …
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)
… the Provision of Services (Report 2018-N-5 ). About the Program In New York State, the Commissioner of Education … for the referral, evaluation, Individualized Education Program (IEP) development, and placement of students in …
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, … to a hospital will increase. Medicaid will only pay for medical care and services that are medically necessary, … and that meet existing standards of professional practice. For the five-year period ended December 31, 2017, Medicaid …
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
… Purpose To determine whether the costs reported by Northside Center for Child Development (Northside) on its Consolidated Fiscal … (CFR) were reasonable, necessary, directly related to the special education program, and sufficiently documented … To determine whether the costs reported by Northside Center for Child Development …
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