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DiNapoli: Former Medical Office Manager Arrested for Scheme to Defraud the New York State Health Insurance Plan
… the arrest yesterday of Gina Bradshaw, an officer manager for numerous doctors’ offices in Manhattan, for her alleged role in a long-term scheme to defraud the New … out of over $12,000 by submitting fraudulent claims for reimbursement. The arrest was the result of a joint …
https://www.osc.ny.gov/press/releases/2023/09/dinapoli-former-medical-office-manager-arrested-scheme-defraud-new-york-state-health-insurance-planOverpayments for Services Also Covered By Medicare Part B (Follow-Up) (2015-F-4)
We have followed up on the actions taken by officials of the Department of Health (Department) to implement the recommendations contained in our audit report, O
https://www.osc.ny.gov/files/state-agencies/audits/pdf/sga-2015-15f4.pdfMedicare Part D – Federal Prescription Drug Benefits Program
This bulletin highlights the Medicare Part D Federal prescription drug benefits program and provides appropriate accounting guidance for Federal subsidies recei
https://www.osc.ny.gov/files/local-government/publications/pdf/medicared.pdfWillsboro Central School District – Student State Aid (2023M-119)
… received services in summer placements. As a result, as of June 30, 2023, the District had not claimed $55,771 in State aid to which it was entitled, of which $52,640 would have already been received and …
https://www.osc.ny.gov/local-government/audits/school-district/2024/02/02/willsboro-central-school-district-student-state-aid-2023m-119State Agencies Bulletin No. 1280
… income. Affected Employees Employees who participated in the PEF or CSEA Certification, Licensure and Exam Fee … CLEFR amount will be reported on the employee’s Form W-2 in box 14 under code FRB . Communication to Affected A letter … are informed of the taxability upon enrollment in the program. Questions Questions regarding this bulletin …
https://www.osc.ny.gov/state-agencies/payroll-bulletins/state-agencies/1280-certification-licensure-and-exam-fee-reimbursement-clefr-2013State Agencies Bulletin No. 919
… in the same paycheck, different tax treatment for these two types of earnings is required. This may occur when an …
https://www.osc.ny.gov/state-agencies/payroll-bulletins/state-agencies/919-taxation-retroactive-raise-payments-employees-receiving-military-stipendCity of Amsterdam – Budget Review (B24-5-5)
… exceed $8.3 million to liquidate the cumulative deficits in the City’s general, transportation, sewer and recreation … The significant revenue and expenditure projections in the 2024-25 proposed budget are reasonable. However, we … City officials did not implement all recommendations in our previous budget review letter when preparing the …
https://www.osc.ny.gov/local-government/audits/city/2024/05/13/city-amsterdam-budget-review-b24-5-5Improper Medicaid Payments to Hospitals for Outpatient Services Billed as Inpatient Services for Recipients Enrolled in Managed Care
… billed as inpatient services for recipients enrolled in managed care. The audit covered the period from July 2019 … & Medicaid Services (CMS) defines outpatient care provided in a hospital as care that a patient receives, typically in the emergency department or observation room, without …
https://www.osc.ny.gov/state-agencies/audits/2024/08/28/improper-medicaid-payments-hospitals-outpatient-services-billed-inpatient-servicesMedicaid Program – Improper Medicaid Payments During Permissible Overlapping Medicaid and Essential Plan Coverage
… individuals who, generally, don’t otherwise qualify for Medicaid. As income, household makeup, and other factors … Plan coverage because the Department did not account for the Essential Plan as a liable third-party health … both programs and having enrollment information for both in its systems, the Department never applied payment …
https://www.osc.ny.gov/state-agencies/audits/2023/09/14/medicaid-program-improper-medicaid-payments-during-permissible-overlapping-medicaid-andEmpire BlueCross BlueShield – Selected Payments for Special Items for the Period April 1, 2011 Through June 30, 2011 (Follow-Up)
… initial audit report. Of the three prior recommendations, two were implemented and one was partially implemented. Empire recovered the …
https://www.osc.ny.gov/state-agencies/audits/2014/10/30/empire-bluecross-blueshield-selected-payments-special-items-period-april-1-2011-throughMedicaid Program – Claims Processing Activity October 1, 2021 Through March 31, 2022
… were submitted by approved providers, were processed in accordance with Medicaid requirements, and resulted in correct payments to the providers. The audit covered the … 2022, eMedNY processed over 294 million claims, resulting in payments to providers of nearly $42 billion. The claims …
https://www.osc.ny.gov/state-agencies/audits/2022/12/13/medicaid-program-claims-processing-activity-october-1-2021-through-march-31-2022Medicaid Program – Claims Processing Activity October 1, 2022 Through March 31, 2023
… were submitted by approved providers, were processed in accordance with Medicaid requirements, and resulted in correct payments to providers. The audit covered the … 2023, eMedNY processed over 233 million claims, resulting in payments to providers of nearly $45 billion. The claims …
https://www.osc.ny.gov/state-agencies/audits/2023/10/25/medicaid-program-claims-processing-activity-october-1-2022-through-march-31-2023Benchmark Family Services, Inc. – Compliance With the Reimbursable Cost Manual
… calculated, adequately documented, and allowable under the State Education Department’s (SED) guidelines, including the … services using reimbursement rates set by SED; the State, in turn, reimburses the counties 59.5 percent of the …
https://www.osc.ny.gov/state-agencies/audits/2016/12/29/benchmark-family-services-inc-compliance-reimbursable-cost-manualRochester Childfirst Network – Compliance With the Reimbursable Cost Manual
… calculated, adequately documented, and allowable under the State Education Department’s (SED) guidelines, including the … services using reimbursement rates set by SED; the State, in turn, reimburses the county 59.5 percent of the …
https://www.osc.ny.gov/state-agencies/audits/2016/11/17/rochester-childfirst-network-compliance-reimbursable-cost-manualDiNapoli: New York State Gets 91 Cents for Every Dollar Sent to Washington
… For every dollar New York sends to Washington D.C., it receives about 91 cents … released today by State Comptroller Thomas P. DiNapoli. New York ranked 46th in the nation in its balance of payments … average of $4,139, ranking New York sixth in the nation. Connecticut was first at $8,479. The largest of the broad …
https://www.osc.ny.gov/press/releases/2015/10/dinapoli-new-york-state-gets-91-cents-every-dollar-sent-washingtonTown of Babylon – Financial Condition and Internal Controls Over Selected Town Operations (2013M-115)
… and four Board members. The Town’s major operating funds’ expenditures were approximately $145 million in 2012. …
https://www.osc.ny.gov/local-government/audits/town/2013/11/22/town-babylon-financial-condition-and-internal-controls-over-selected-town-operationsReimbursement of Homeless Shelter Providers – Westhab Inc.’s Coachman Family Center (Follow-Up)
… – Westhab Inc.’s Coachman Family Center (Report 2020-S-56 ). About the Program The Office of Temporary and …
https://www.osc.ny.gov/state-agencies/audits/2024/08/08/reimbursement-homeless-shelter-providers-westhab-incs-coachman-family-center-followOversight of Smart Schools Bond Act Funds
… Objective To determine whether the State Education Department (Department) is monitoring the use … The Smart Schools Bond Act (Act) was approved by New York State voters in November 2014, authorizing the issuance of up …
https://www.osc.ny.gov/state-agencies/audits/2020/06/10/oversight-smart-schools-bond-act-fundsMedicaid Program – Excessive Payments for Durable Medical Equipment Rentals
… the State’s Medicaid program. The Department uses two methods to pay for Medicaid services: fee-for-service … MCOs’ established monthly rental caps. For example, one MCO established a 10-month rental cap on apnea monitors, yet for one recipient the MCO paid $10,450 on 64 extra rental …
https://www.osc.ny.gov/state-agencies/audits/2023/04/12/medicaid-program-excessive-payments-durable-medical-equipment-rentalsDiNapoli: Middletown Chiropractor Sentenced to Nine Years for Insurance Fraud
… State Comptroller Thomas P. DiNapoli announced James “Jay” … health insurance fraud which systematically defrauded the state, federal and private insurers of millions of dollars,” …
https://www.osc.ny.gov/press/releases/2021/04/dinapoli-middletown-chiropractor-sentenced-nine-years-insurance-fraud