Search
Excessive Medicaid Payments for Services to Recipients Receiving Medicare Benefits (Follow-Up)
… Purpose To determine the extent of implementation of the three recommendations included in our initial audit … provided to dual eligible individuals. About $500 million of this amount occurred because the Department did not ensure … Determine the extent of implementation of 3 recommendations incld in our initial …
https://www.osc.ny.gov/state-agencies/audits/2013/04/26/excessive-medicaid-payments-services-recipients-receiving-medicare-benefits-followAstor Services for Children & Families – Compliance With the Reimbursable Cost Manual
… Purpose To determine whether the costs reported by Astor Services for Children & Families (Astor) on its Consolidated Fiscal … calculated, adequately documented and allowable under the State Education Department’s (SED’s) guidelines, … To determine whether the costs reported by Astor Services for Children Families …
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)
… extent of implementation of the six recommendations made in our audit report, Improper Payments for Controlled … pharmacies $1,183,601 for 13,705 fee-for-service claims in which quantities of controlled substances exceeded the … 3,323 managed care claims for controlled substances in which the quantities dispensed exceeded the limits set by …
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) … (Manual). The audit included all expenses claimed on Starting Point’s CFR for the fiscal year ended June 30, 2013, …
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
… 1, 2012 to August 31, 2013. Background The New York State Health Insurance Program (NYSHIP) provides health insurance … procedure that was performed on the same day for the same patient. Modifier 59 is used to identify procedures or … from the removal of the tumor. However, the medical records did not support the provider’s use of modifier 59 on …
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 … documented, program related, and allowable pursuant to the State Education Department’s (SED) Reimbursable Cost … Determine whether the costs reported by Milestone School for Child Development …
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
… Purpose We audited the New York City Department of Health and Mental Hygiene’s (DOHMH) … administration of a contract (#113 225 01) with the Center for Urban Community Services (CUCS) for the period July 1, … We audited the New York City Department of Health and Mental Hygienes …
https://www.osc.ny.gov/state-agencies/audits/2016/02/16/administration-contract-center-urban-community-servicesMedicaid Overpayments for Inpatient Transfer Claims Among Merged or Consolidated Facilities
… who were transferred between merged or consolidated hospitals and whether corresponding overpayments occurred. … include establishing Medicaid policies for reimbursing hospitals and other health care providers for their services. … when a Medicaid recipient is transferred among different hospitals, two separate payments are made: a payment for the …
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
… Purpose To determine whether Medicaid overpaid hospitals by … higher levels of medical care than those actually provided to patients. The audit covers the period April 1, 2005 … To determine whether Medicaid overpaid hospitals by reimbursing for higher levels …
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
… $1.3 million in reimbursable expenses. All Services' CFR for the fiscal year ended June 30, 2011 had not been … - Compliance With the Reimbursable Cost Manual (2011-S-13) State Education Department: IncludED Educational …
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
… Objective To determine if Medicaid made improper Medicare premium payments on behalf of recipients enrolled in … our audit scope: Medicaid made $31.7 million in improper Medicare premium payments on behalf of 42,586 individuals who … To determine if Medicaid made improper Medicare premium payments on behalf of recipients enrolled in …
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)
… (Report 2016-S-73 ). About the Program The New York State Medicaid program provides a wide range of medical … and/or have special health care needs. Many of the State’s Medicaid recipients are also enrolled in Medicare. … 2017 for therapy services. The audit concluded that the State’s Medicaid program paid $20.1 million for services …
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
… procedures. The audit covered the period January 1, 2014 through June 30, 2019. About the Program The New York … through June 30, 2019, Empire paid over $1.5 million for 3,169 special item intraocular lens claims. Key Finding We reviewed the 3,169 special item intraocular lens claims paid during the …
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)
… Comprehensive Third-Party Insurance (Report 2016-S-60 ). About the Program Mainstream managed care (the managed …
https://www.osc.ny.gov/state-agencies/audits/2020/01/17/managed-care-premium-payments-recipients-comprehensive-third-party-insurance-followMedicaid Overpayments for Medicare Part B Services Billed Directly to eMedNY (Follow-Up)
… of the five recommendations included in our initial audit report, Medicaid Overpayments for Medicare Part B Services Billed Directly to eMedNY … of the five recommendations included in our initial audit report Medicaid Overpayments for Medicare Part B Services …
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
… million for prescription, OTC, and compound drugs were not part of the rate adjustment process due to Department errors … drugs totaling nearly $8.6 million were not part of the rate adjustment because the Department …
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)
… Individualized Education Program (IEP) development, and placement of students in special education. The New York City … this end, the DOE follows a multi-step evaluation and placement process. The provision of special education … services and programs. The audit scope covered the period of July 1, 2016 through January 21, 2020 and included …
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
… with disabilities who are between three and five years of age. For purposes of this report, these programs are collectively referred to … five employees worked for the program or the allocation of costs for one employee. The Manual requires that providers …
https://www.osc.ny.gov/state-agencies/audits/2019/01/11/northside-center-child-development-compliance-reimbursable-cost-manual