Search
Improper Payments for Controlled Substances That Exceed Allowed Dispensing Limits (Follow-Up)
… Purpose To determine the extent of implementation of the six recommendations made in our audit report, Improper … To determine the extent of implementation of the six recommendations made in our …
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)
… action to help ensure managed care enrollment information is entered and update timely and to determine why certain …
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
… During the 2012-13 school year, Starting Point served 942 students. The New York City Department of Education (DoE) … costs. Among the disallowances we identified were: $1,981,802 in non-reimbursable shared staff compensation costs. This included $1,502,245 in ineligible salaries and $479,557 in related …
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
… To determine whether UnitedHealthcare improperly paid for medical services designated with modifier code 59 that were … with UnitedHealthcare (United) to process and pay medical and surgical claims for services provided to Empire Plan members. United’s payments to medical providers are based, in part, on procedure codes …
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
… 110 students. The New York City Department of Education (DoE) refers students to Milestone based on clinical … and properly documented. SED reimburses DoE for a portion of its payments to Milestone based on …
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
… services, including supportive housing. Supportive housing is designed to help individuals and families use housing as a …
https://www.osc.ny.gov/state-agencies/audits/2016/02/16/administration-contract-center-urban-community-servicesMedicaid Program – Overpayments of Hospitals' Claims for Lengthy Acute Care Admissions
… hospitals by reimbursing for higher levels of medical care than those actually provided to patients. The audit … Medicaid recipients in need of inpatient hospital care are provided a full range of necessary diagnostic, palliative and therapeutic care, including but not limited to surgical, medical, …
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
… minor children, unaccounted-for equipment items, and cable television. Key Recommendation SED officials should review …
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
… payments on behalf of recipients enrolled in the Medicare buyin program …
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)
To assess the extent of implementation of the three recommendations included in our initial audit report Overpayments for Therapy Services and Prescription Drugs Covered by Medicare Report 2016S73
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
… lens and replacing it with an intraocular lens (such as a plastic lens). Empire generally reimburses the intraocular … 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-followOpioid Prescriptions for Medicaid Recipients in an Opioid Treatment Program (Follow-Up)
… of implementation of the three recommendations included in our initial audit report, Opioid Prescriptions for Medicaid Recipients in an Opioid Treatment Program (Report 2017-S-66 ). About the … prescriptions. I-STOP is a tool to assist prescribers in determining the most appropriate treatment for an …
https://www.osc.ny.gov/state-agencies/audits/2020/05/07/opioid-prescriptions-medicaid-recipients-opioid-treatment-program-followMedicaid Overpayments for Medicare Part B Services Billed Directly to eMedNY (Follow-Up)
… Part B Services Billed Directly to eMedNY (Report 2017-S-36 ). About the Program The Department of Health (Department) …
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
To determine whether Medicaid inappropriately paid for drugs from manufacturers that did not enter into a national drug rebate agreement NDRA
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)
… IEP. We also assessed the time frames for students to commence receiving services and programs. The audit scope … that DOE was not adequately managing this process as it did not track or calculate its compliance with the required time frame for arranging services, nor did it calculate or track other critical performance measures …
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, as the … to a hospital will increase. Medicaid will only pay for medical care and services that are medically necessary, …
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
… determine whether the costs reported by Northside Center for Child Development (Northside) on its Consolidated Fiscal … To determine whether the costs reported by Northside Center for Child Development Northside on its Consolidated Fiscal …
https://www.osc.ny.gov/state-agencies/audits/2019/01/11/northside-center-child-development-compliance-reimbursable-cost-manualMedicaid Program – Improper Fee-for-Service Payments for Services Covered by Managed Care
… for certain services covered by mainstream managed care plans. Our audit covered the period January 1, 2013 to … pays Medicaid providers using the FFS or managed care method. Under the FFS method, the Department, through … rendered to Medicaid recipients. Under the managed care method, the Department pays managed care plans a monthly …
https://www.osc.ny.gov/state-agencies/audits/2019/01/10/medicaid-program-improper-fee-service-payments-services-covered-managed-careYork College – Time and Attendance Practices for Public Safety Staff (Follow-Up)
… recommendations included in our initial audit report, Time and Attendance Practices for Public Safety Staff ( 2013-S-65 ). Background Our initial … nor York College had adequate internal controls over time and attendance for Public Safety officers. No one was …
https://www.osc.ny.gov/state-agencies/audits/2018/12/28/york-college-time-and-attendance-practices-public-safety-staff-follow