Search
Medicaid 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 – 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-residencySt. 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-followMedicaid 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-emednyMonitoring of Not-for-Profit Cemeteries for Fiscal Stability and Adequate Facility Maintenance (Follow-Up)
… maintenance, and preservation of burial grounds for all not-for-profit cemetery corporations (cemeteries) in New … to broadly and routinely analyze the fiscal health of all 1,745 cemeteries under its jurisdiction. As a result, it … to be underfunded by a median of at least $25,500. All 71 cemeteries we visited appeared well maintained, but 38 …
https://www.osc.ny.gov/state-agencies/audits/2018/12/27/monitoring-not-profit-cemeteries-fiscal-stability-and-adequate-facility-maintenance-followMedicaid 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-medicareState Comptroller DiNapoli Positions New York Pension Fund For Low Carbon Future
… Thomas P. DiNapoli today announced an investment strategy that will raise the New York Common Retirement … which has helped inform and inspire the Fund’s low carbon strategy. The full report is here: … considerations into account as part of their long-term strategy. The Fund is committed to the belief that …
https://www.osc.ny.gov/press/releases/2015/12/state-comptroller-dinapoli-positions-new-york-pension-fund-low-carbon-futureDiNapoli Audit Highlights Need for Better Compliance with School Violence Reporting Law
… Act was passed by the state Legislature in 2000 to boost school safety and address violence in our public schools,” … extent to which the seventh school, Burgard Vocational High School in Buffalo, underreported because it used an … and reporting methodology. Findings include: East High School in Rochester reported 256 VADIR incidents, but …
https://www.osc.ny.gov/press/releases/2015/01/dinapoli-audit-highlights-need-better-compliance-school-violence-reporting-lawGlobal Investor Coalition Calls on Exxon to Prepare for a Lower Carbon Future
… DiNapoli and the Church of England are urging ExxonMobil to disclose the resilience of its business model in the wake … in Exxon shares. “The unprecedented Paris agreement to rein in global warming may significantly affect Exxon’s … State Common Retirement Fund. “As shareholders, we want to know that Exxon is doing what is needed to prepare for a …
https://www.osc.ny.gov/press/releases/2016/01/global-investor-coalition-calls-exxon-prepare-lower-carbon-futureDiNapoli Warns Changing Fiscal Landscape Could Increase Budget Challenges for Local Governments
… represents the smallest portion of overall revenue for local governments, it was the fastest growing source of … aid to local governments. The State Fiscal Year (SFY) 2024-2025 Enacted Budget provides $715 million in AIM funding for … Budget for all AIM recipients is proposed in the SFY 2025-26 Executive Budget to continue for just one more year. …
https://www.osc.ny.gov/press/releases/2025/02/dinapoli-warns-changing-fiscal-landscape-could-increase-budget-challenges-local-governments