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Payments for Fraudulent and Improper Claims Submitted by Davis Ethical Pharmacy (Follow-Up)
… Payments for Fraudulent and Improper Claims Submitted by Davis Ethical Pharmacy (2012-S-11). Background Our initial … 2011, Medicaid made improper payments totaling $94,460 to Davis Ethical Pharmacy. Based on information obtained from … indicated on the claims), auditors determined that Davis Ethical likely fabricated nearly all of the improper …
https://www.osc.ny.gov/state-agencies/audits/2016/02/18/payments-fraudulent-and-improper-claims-submitted-davis-ethical-pharmacy-followMedicaid Program – Improper Fee-for-Service Payments for Pharmacy Services Covered by Managed Care
… Purpose To determine whether Medicaid made improper fee-for-service claim payments for … October 1, 2011 through December 31, 2013. Background Medicaid provides a wide range of medical services to those … and/or have special health care needs. In general, the Medicaid program pays medical providers through either the …
https://www.osc.ny.gov/state-agencies/audits/2015/01/05/medicaid-program-improper-fee-service-payments-pharmacy-services-covered-managed-careEducators for Children, Youth and Families, Inc. – Use of Contract Funds (Follow-Up)
… submitted periodic expenditure reports to SED and OCFS. We reviewed claims amounting to $1.8 million, out of $3.2 million in contract payments, to determine if the claims were properly supported and appropriate. These … four administered by SED and three administered by OCFS. We found that Educators could not support or justify $883,530 …
https://www.osc.ny.gov/state-agencies/audits/2013/08/13/educators-children-youth-and-families-inc-use-contract-funds-followMedicaid Program – Improper Payments for Ancillary Services Provided During Hospital Inpatient Admissions
… for review. Medicaid reimbursement rates for inpatient hospital claims include the costs of most medical care provided during a hospital admission. As such, claims for ancillary services provided during a hospital admission are generally not reimbursable. In 2007, …
https://www.osc.ny.gov/state-agencies/audits/2014/04/03/medicaid-program-improper-payments-ancillary-services-provided-during-hospital-inpatientMedicaid Program – Medicaid Payments for Pharmacy Claims: Joia Pharmacy and a Related Prescriber
… To determine whether Medicaid made proper payments to Joia Pharmacy, Inc. (Joia) and a related prescriber (herein … During the audit period, Joia, doing business as Soho Pharmacy, was a privately owned pharmacy located in Lower Manhattan. Soho Pharmacy was still …
https://www.osc.ny.gov/state-agencies/audits/2017/06/27/medicaid-program-medicaid-payments-pharmacy-claims-joia-pharmacy-and-related-prescriberOversight of Hotels and Motels Used for Homeless and Mixed-Use Temporary Residency
… Purpose To determine if the Office of Temporary and Disability Assistance (OTDA) and the Department of Health (DOH) are adequately ensuring that hotels and … 16, 2016. Background According to a 2016 Department of Housing and Urban Development report, of the more than …
https://www.osc.ny.gov/state-agencies/audits/2017/06/27/oversight-hotels-and-motels-used-homeless-and-mixed-use-temporary-residencyMedicaid Program – Reducing Medicaid Costs for Recipients With End Stage Renal Disease
… Department of Health took sufficient steps to control the Medicaid costs of recipients diagnosed with end stage renal … alive. For the six-year period ended December 31, 2015, Medicaid paid $909 million for medical services (including … equipment, and laboratory services) on behalf of 10,906 Medicaid recipients who were diagnosed with ESRD. Medicaid …
https://www.osc.ny.gov/state-agencies/audits/2017/03/01/medicaid-program-reducing-medicaid-costs-recipients-end-stage-renal-diseaseSt. Mary’s Hospital for Children, Inc. – Compliance With the Reimbursable Cost Manual
… To determine whether the costs reported by St Marys Hospital for Children Inc on its Consolidated Fiscal …
https://www.osc.ny.gov/state-agencies/audits/2022/11/09/st-marys-hospital-children-inc-compliance-reimbursable-cost-manualImproper Fee-for-Service Payments for Services Covered by Managed Long-Term Care Plans (Follow-Up)
… Covered by Managed Long-Term Care Plans (Report 2018-S-65 ). About the Program The State’s Medicaid program offers …
https://www.osc.ny.gov/state-agencies/audits/2021/08/31/improper-fee-service-payments-services-covered-managed-long-term-care-plans-followQuality Services for the Autism Community – Compliance With the Reimbursable Cost Manual
… a total of $16,503 in OTPS costs consisting of: $11,607 in rent, which consisted of $8,582 in direct rent and $3,025 in administration rent because QSAC did not claim the actual rent only; …
https://www.osc.ny.gov/state-agencies/audits/2019/12/31/quality-services-autism-community-compliance-reimbursable-cost-manualMedicaid Program – Improper Fee-for-Service Payments for Services Covered by Long-Term Care Plans
… payments for certain services covered by managed long-term care (MLTC) plans. The audit covered the period January 1, … are enrolled in MLTC plans. MLTC plans provide long-term care services, such as home health care, nursing home care, and durable medical equipment, to …
https://www.osc.ny.gov/state-agencies/audits/2020/01/17/medicaid-program-improper-fee-service-payments-services-covered-long-term-care-plansHebrew Academy for Special Children, Inc. – Compliance With the Reimbursable Cost Manual
… preschool Special Education Itinerant Teacher (SEIT), full- and half-day Special Class (SC), and full- and half-day Special Class in an Integrated Setting …
https://www.osc.ny.gov/state-agencies/audits/2020/02/04/hebrew-academy-special-children-inc-compliance-reimbursable-cost-manualAdministration of the Contract With the Postgraduate Center for Mental Health (Follow-Up)
… Objective To determine the extent of implementation of the nine recommendations included in our initial audit … of the Contract With the Postgraduate Center for Mental Health ( 2015-S-88 ). About the Program Our initial report, … To determine the extent of implementation of the nine recommendations …
https://www.osc.ny.gov/state-agencies/audits/2020/09/15/administration-contract-postgraduate-center-mental-health-followImproper Medicaid Payments for Individuals Receiving Hospice Services Covered by Medicare (Follow-Up)
… covered by Medicare. The audit covered the period January 1, 2015 through July 31, 2019. We determined the Department …
https://www.osc.ny.gov/state-agencies/audits/2023/02/13/improper-medicaid-payments-individuals-receiving-hospice-services-covered-medicare-followMedicaid Program – Improper Fee-for-Service Pharmacy Payments for Recipients With Third-Party Health Insurance
… Objective To determine if Medicaid made inappropriate fee-for-service payments to pharmacies on behalf of recipients … have other third-party health insurance (TPHI) for pharmacy services in addition to Medicaid (e.g., … made for services that should have been paid for by a recipient’s TPHI. During the audit period, Gainwell’s …
https://www.osc.ny.gov/state-agencies/audits/2023/05/11/medicaid-program-improper-fee-service-pharmacy-payments-recipients-third-party-healthMedicaid Program – Improper Medicaid Payments for Outpatient Services Billed as Inpatient Claims
… in the same day. Medicaid uses the All Patient Refined Diagnosis Related Groups (DRG) methodology to reimburse … DRG methodology classifies recipients according to their diagnosis and severity of illness, which provides the basis …
https://www.osc.ny.gov/state-agencies/audits/2023/08/30/medicaid-program-improper-medicaid-payments-outpatient-services-billed-inpatient-claimsChildren’s Unit for Treatment and Evaluation – Compliance With the Reimbursable Cost Manual
… To determine whether the costs reported by Childrens Unit for Treatment and Evaluation on its …
https://www.osc.ny.gov/state-agencies/audits/2019/07/15/childrens-unit-treatment-and-evaluation-compliance-reimbursable-cost-manualMedicaid Program – Medicaid Overpayments for Medicare Part B Services Billed Directly to eMedNY
… After the deductible is met, Medicare begins to pay its share and the enrollee is responsible for any coinsurance. … to minimize the need for providers to self-report Medicare claim data to eMedNY and thereby improve the accuracy of … appropriate. Formally advise providers to report accurate claim information when billing Medicaid for Part B …
https://www.osc.ny.gov/state-agencies/audits/2018/12/11/medicaid-program-medicaid-overpayments-medicare-part-b-services-billed-directly-emednyMedicaid Program – Opioid Prescriptions for Medicaid Recipients in an Opioid Treatment Program
… for people diagnosed with an opioid use disorder. New York State maintains a database to monitor prescription …
https://www.osc.ny.gov/state-agencies/audits/2018/11/20/medicaid-program-opioid-prescriptions-medicaid-recipients-opioid-treatment-programMedicaid Program – Overpayments for Therapy Services and Prescription Drugs Covered by Medicare
… Objective To determine if the Department of Health overpaid health care providers’ Medicaid claims for therapy services and prescription drugs that are covered by Medicare. The audit covered the period January 1, 2012 to December 31, 2016 for prescription drugs and January 1, …
https://www.osc.ny.gov/state-agencies/audits/2019/10/30/medicaid-program-overpayments-therapy-services-and-prescription-drugs-covered-medicare