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DiNapoli: Audit Shows Health Department Overpaid Certain Medicaid Managed Care Premiums
… Medicaid managed care. Medicaid pays MCOs a monthly premium payment for each enrolled Medicaid recipient and the MCOs … also contributed to the overpayments. DOH’s cost reporting instructions failed to provide clear and specific …
https://www.osc.ny.gov/press/releases/2016/10/dinapoli-audit-shows-health-department-overpaid-certain-medicaid-managed-care-premiumsOperational Advisory No. 33
… account codes Guidance : The Office of the State Comptroller (OSC) has updated the guidance for the use … Service – Supplies and Materials … The Office of the State Comptroller OSC has updated the guidance for the use of …
https://www.osc.ny.gov/state-agencies/advisories/operational-advisory/33-gfo-updates-postageshipping-account-codesMedicaid Overpayments for Inpatient Transfer Claims Among Merged or Consolidated Facilities
… Health established adequate controls over inpatient claims for recipients who were transferred between merged or … responsibilities include establishing Medicaid policies for reimbursing hospitals and other health care providers for their services. Generally, when a Medicaid recipient is …
https://www.osc.ny.gov/state-agencies/audits/2015/12/08/medicaid-overpayments-inpatient-transfer-claims-among-merged-or-consolidated-facilitiesTown of Boonville – Claims Auditing and Conflict of Interest (2014M-373)
… and to determine if there were any conflicts of interest for the period January 1, 2013 through June 30, 2014. … an elected five-member Town Board. Budgeted appropriations for 2014 were approximately $1.5 million for the general and … officer whose action gave rise to the claim. Ensure that all officials and employees are familiar with the …
https://www.osc.ny.gov/local-government/audits/town/2015/03/06/town-boonville-claims-auditing-and-conflict-interest-2014m-373Willsboro Central School District – Student State Aid (2023M-119)
… manner for all special education students. Review all unclaimed State aid and submit any eligible claims for …
https://www.osc.ny.gov/local-government/audits/school-district/2024/02/02/willsboro-central-school-district-student-state-aid-2023m-119United HealthCare – Overpayments for Services Provided by Eastern Orange Ambulatory Surgery Center
… participating providers who agree to accept payments, at rates established by United, to furnish medical services … United reimburses claims from non-participating providers at amounts that are generally higher (and often significantly … This caused United to continue to make overpayments. At the time of our audit fieldwork, United was negotiating …
https://www.osc.ny.gov/state-agencies/audits/2016/05/05/united-healthcare-overpayments-services-provided-eastern-orange-ambulatory-surgery-centerHillside Public Library of New Hyde Park – Claims Processing (2017M-175)
… Purpose of Audit The purpose of our audit was to examine the Library’s claims process for … October 31, 2016. Background The Hillside Public Library of New Hyde Park (Library) is a school district public …
https://www.osc.ny.gov/local-government/audits/library/2017/12/08/hillside-public-library-new-hyde-park-claims-processing-2017m-175Town of Hounsfield - Claims Auditing (2019M-215)
… totaling $783,400, the Supervisor paid $124,000 in claims (16 percent) that were either not presented to the Board or …
https://www.osc.ny.gov/local-government/audits/town/2020/01/24/town-hounsfield-claims-auditing-2019m-215United HealthCare – Overpayments for Services Provided by Long Island Laparoscopic Surgery
… The Empire Plan is the primary health benefits plan for NYSHIP, covering a range of services from inpatient … process and pay medical claims from health care providers for services provided to Empire Plan members. United … pay a nominal co-payment to the participating provider for the services rendered. Members may also choose to receive …
https://www.osc.ny.gov/state-agencies/audits/2016/05/05/united-healthcare-overpayments-services-provided-long-island-laparoscopic-surgeryUnited HealthCare – Overpayments for Services Provided by Long Island Spine Specialists
… Spine Specialists, P.C. waived Empire Plan members’ out-of-pocket costs, and if so, to quantify the overpayments made … primary health benefits plan for NYSHIP, covering a range of services from inpatient hospital care to outpatient … HealthCare - Overpayments for Services at the South Shore Ambulatory Surgery Center (2008-S-11) … To …
https://www.osc.ny.gov/state-agencies/audits/2016/05/05/united-healthcare-overpayments-services-provided-long-island-spine-specialistsLynbrook Union Free School District – Medicaid Reimbursements (2022M-81)
… properly filed, the District may have realized $10,107 in additional Medicaid reimbursements. In addition, officials: Did not establish written Medicaid claim procedures or provide supervision over the Medicaid …
https://www.osc.ny.gov/local-government/audits/school-district/2022/11/10/lynbrook-union-free-school-district-medicaid-reimbursements-2022m-81DiNapoli: Three Syracuse School District Employees Charged With Fraud in Scheme
… County District Attorney William Fitzpatrick announced today that three employees of the Syracuse City School … County District Attorney William Fitzpatrick announced today that three employees of the Syracuse City School …
https://www.osc.ny.gov/press/releases/2021/05/dinapoli-three-syracuse-school-district-employees-charged-fraud-schemeTown of Waterford - Town Clerk Collections (2018M-265)
… fees intact. Adequately support collections and the form of payment was not always recorded. Receipts for the 2016 and … Maintain receipts or another acceptable form of documentation for all collections that include the payer, purpose, amount, date of receipt and form of payment. Make deposits of all …
https://www.osc.ny.gov/local-government/audits/town/2019/05/03/town-waterford-town-clerk-collections-2018m-265State Agencies Bulletin No. 837
… Purpose To advise agencies of the change in providing corrected wage information to employees. Affected Employees Employees who … remain subject to Federal income tax for that year.* A Form W-2c for the prior year must be issued but the amount of …
https://www.osc.ny.gov/state-agencies/payroll-bulletins/state-agencies/837-change-processing-form-w-2c-corrected-wage-and-tax-statement-andDiNapoli: State Health Department Missed $119 Million in Rebates from Drug Companies
… of Health (DOH) failed to collect nearly $120 million in available rebates over a 33-month period from prescription … from drug companies,” DiNapoli said. “DOH must be diligent in its pursuit of rebates and do all it can to save money. … These actions should greatly benefit New York taxpayers.” In 1990, Congress created the Medicaid Drug Rebate Program to …
https://www.osc.ny.gov/press/releases/2015/02/dinapoli-state-health-department-missed-119-million-rebates-drug-companiesAccounts Payable Advisory No. 64
… was stolen and cashed by a party other than the payee. In such instances, the vendor must complete an affidavit. The …
https://www.osc.ny.gov/state-agencies/advisories/accounts-payable-advisory/64-forgery-checksIndian Lake Central School District – Medicaid Reimbursements (2021M-150)
… services provided. The District lacked adequate procedures to ensure Medicaid claims were submitted and reimbursed. … costs. Key Recommendations Establish adequate procedures to ensure all documentation requirements are met to submit Medicaid claims for reimbursement for eligible …
https://www.osc.ny.gov/local-government/audits/school-district/2021/12/10/indian-lake-central-school-district-medicaid-reimbursements-2021m-150Dutchess County – Contract Monitoring (2023M-142)
… ensured that contracted vendors provided services in accordance with contract terms, and that payments were … certain services with contracted vendors were provided in accordance with contract terms and payments were … provided by the vendor were reviewed before approving the claim. The Comptroller approved claims for payment totaling …
https://www.osc.ny.gov/local-government/audits/county/2024/08/09/dutchess-county-contract-monitoring-2023m-142Chateaugay Central School District – Nonresident Homeless Student State Aid (2023M-153)
… officials did not establish policies and procedures to ensure State aid was claimed for nonresident homeless … complete and maintain designation forms and submit them to the New York State Education Department (SED). Key Recommendations Establish policies and procedures to ensure State aid claims are accurately prepared and …
https://www.osc.ny.gov/local-government/audits/school-district/2024/03/01/chateaugay-central-school-district-nonresident-homeless-student-state-aidCoeymans Hollow Fire Corporation – Board Oversight (2022M-84)
… or enforce adequate bylaws. Review claim documentation for appropriateness and did not sign vouchers to approve claims for payment. Establish adequate controls to ensure that all … and Financial Secretary performed bank reconciliations for Company accounts. Key Recommendations Amend the bylaws …
https://www.osc.ny.gov/local-government/audits/fire-company-or-department/2022/11/10/coeymans-hollow-fire-corporation-board-oversight-2022m-84