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Improper Medicaid Payments for Outpatient Services Billed as Inpatient Claims (Follow-Up)
… and outpatient services. A recipient’s status in a hospital—inpatient versus outpatient—affects Medicaid’s … generally requires recipients to stay overnight in the hospital and be monitored by the health care team at the … reported Medicaid recipients were discharged within 24 hours of admission. We selected a judgmental sample of 190 of …
https://www.osc.ny.gov/state-agencies/audits/2025/03/12/improper-medicaid-payments-outpatient-services-billed-inpatient-claims-followImproper Payments Related to the Center of Excellence for Cancer Program
… (Cancer Program). The audit covered claims with a date of service during the period from January 2019 through December 2024. About the Program The New York State Health Insurance Program (NYSHIP), administered by the Department of … Excellence for Cancer Program (Cancer Program), a select group of providers recognized as leaders in the field of …
https://www.osc.ny.gov/state-agencies/audits/2026/01/27/improper-payments-related-center-excellence-cancer-programDiNapoli: California Parcel Worker Arrested for Allegedly Stealing $120K in Checks
… 24 payroll checks, while working in a parcel distribution center. Rodriguez, 25, of Chula Vista, was charged with grand … collaboration in solving complex cases. I’m proud of the work our Property Crimes detectives did alongside our … who was working in a parcel service distribution center in Chula Vista not only allegedly stole the 529 …
https://www.osc.ny.gov/press/releases/2026/03/dinapoli-california-parcel-worker-arrested-allegedly-stealing-120k-checksMay 1998: Accounting Requirements and Program Information for Multi-Modal Transportation Program
… airport layout plan; and county, town, city and village roads, highways, parkways and bridges. Nomination Process - … with an approved airport layout plan. State or local roads, highways and bridges: that the Multi-Modal funding is …
https://www.osc.ny.gov/local-government/publications/may-1998-accounting-requirements-and-program-information-multi-modal-transportation-programInterdisciplinary Center for Child Development – Compliance With the Reimbursable Cost Manual
… requirements. Other Related Audits/Reports of Interest Lifeline Center for Child Development, Inc.: Compliance With …
https://www.osc.ny.gov/state-agencies/audits/2018/04/05/interdisciplinary-center-child-development-compliance-reimbursable-cost-manualReducing Medicaid Costs for Recipients With End Stage Renal Disease (Follow-Up)
… Purpose To determine the implementation status of the five recommendations made in our initial audit … To determine the implementation status of the five recommendations made in our initial audit …
https://www.osc.ny.gov/state-agencies/audits/2018/09/05/reducing-medicaid-costs-recipients-end-stage-renal-disease-followAdministration of Contract C007373 With the Institute for Community Living
… Purpose To determine whether the Office of Mental Health (OMH) is … through October 22, 2015. Background The mission of OMH is to promote the mental health and well-being of all New … the individuals served. OMH hires independent contractors to operate many of these programs. ICL is one of the largest …
https://www.osc.ny.gov/state-agencies/audits/2016/12/30/administration-contract-c007373-institute-community-livingAdministration of the Contract With the Postgraduate Center for Mental Health
… Purpose To determine whether the Office of Mental Health (OMH) is effectively … administering its Supportive Housing Contract C007374 with the Postgraduate Center for Mental Health (PCMH) by ensuring … only appropriate and supported expenses were reimbursed. The audit focused primarily on the contract year ended June …
https://www.osc.ny.gov/state-agencies/audits/2016/12/30/administration-contract-postgraduate-center-mental-healthWestchester School for Special Children – Compliance With the Reimbursable Cost Manual
… whether the costs reported by the Westchester School for Special Children (WSSC) on its Consolidated Fiscal … SED. SED reimburses DoE and the other school districts for a portion of its payments to WSSC. For the four years ended June 30, 2011, WSSC claimed … whether the costs reported by the Westchester School for Special Children WSSC on its Consolidated Fiscal Reports …
https://www.osc.ny.gov/state-agencies/audits/2013/07/02/westchester-school-special-children-compliance-reimbursable-cost-manualChildren’s Center for Early Learning – Compliance With the Reimbursable Cost Manual
… the Consolidated Fiscal Reports (CFRs) of the Children’s Center for Early Learning (Center) were calculated properly, documented adequately, and … from fiscal years 2005-06 and 2006-07. Background The Center provides special education services to New York … on the Consolidated Fiscal Reports CFRs of the Childrens Center for Early Learning Center were calculated proper …
https://www.osc.ny.gov/state-agencies/audits/2014/12/29/childrens-center-early-learning-compliance-reimbursable-cost-manualWhitestone School for Child Development – Compliance With the Reimbursable Cost Manual
… Purpose To determine whether the costs reported on the Consolidated Fiscal Reports (CFRs) of the Whitestone … costs. To Whitestone: Ensure that costs reported on annual CFRs comply with Manual requirements. Other Related … To determine whether the costs reported on the Consolidated Fiscal Reports of the Whitestone School …
https://www.osc.ny.gov/state-agencies/audits/2015/04/07/whitestone-school-child-development-compliance-reimbursable-cost-manualUnited HealthCare – Overpayments for Services Provided by Long Island Spine Specialists
… Purpose To determine whether Long Island Spine Specialists, P.C. waived Empire Plan members’ … Our audit focused on claims submitted to United by Long Island Spine Specialists, P.C. (Long Island Spine), a non-participating provider located in Long … To determine whether Long Island Spine Specialists PC waived Empire Plan members …
https://www.osc.ny.gov/state-agencies/audits/2016/05/05/united-healthcare-overpayments-services-provided-long-island-spine-specialistsMedicaid Program – Managed Care Organizations’ Readiness for the Encounter Intake System
To determine the readiness of all Medicaid managed care organizations to submit Medicaid encounter transactions to the new Encounter Intake System
https://www.osc.ny.gov/state-agencies/audits/2016/03/29/medicaid-program-managed-care-organizations-readiness-encounter-intake-systemMonitoring of Medicaid Payments for Nursing Home Bed Reserve Days (Follow-Up)
… audit report, Monitoring of Medicaid Payments for Nursing Home Bed Reserve Days (Report 2010-S-21). Background Our … was issued on December 9, 2010, examined whether nursing home claims submitted to Medicaid for hospital bed reserve … days were appropriate, and if not, to what extent nursing home claims exceeded the bed reserve day limits. During the …
https://www.osc.ny.gov/state-agencies/audits/2013/01/10/monitoring-medicaid-payments-nursing-home-bed-reserve-days-followExcessive Medicaid Payments for Services to Recipients Receiving Medicare Benefits (Follow-Up)
… Background Our initial audit report, which was issued on September 20, 2010, examined whether the Department was … eMedNY system to properly apply the 20 percent limitation on coinsurance charges in all cases where it was applicable; … did not properly report Medicare coinsurance amounts on the claims they submitted; and providers’ claims …
https://www.osc.ny.gov/state-agencies/audits/2013/04/26/excessive-medicaid-payments-services-recipients-receiving-medicare-benefits-followUnited HealthCare – Overpayments for Services Provided by Long Island Laparoscopic Surgery
… Purpose To determine whether Long Island Laparoscopic Surgery, PLLC waived Empire Plan members’ … Our audit focused on claims submitted to United by Long Island Laparoscopic Surgery, PLLC (Long Island Laparoscopic), a non-participating provider located in … To determine whether Long Island Laparoscopic Surgery PLLC waived Empire Plan members …
https://www.osc.ny.gov/state-agencies/audits/2016/05/05/united-healthcare-overpayments-services-provided-long-island-laparoscopic-surgeryAstor Services for Children & Families – Compliance With the Reimbursable Cost Manual
… reported by Astor Services for Children & Families (Astor) on its Consolidated Fiscal Report (CFR) were properly … rates set by SED. These reimbursement rates are based on financial information, including costs, that Astor reports to SED on its annual CFR. To be eligible for reimbursement, reported …
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)
… in which quantities of controlled substances exceeded the supply limits allowed by the Act. We further identified 3,323 … from pharmacies for controlled substances that exceeded supply limits allowed by the Act. We recommended that the … for quantities of controlled substances that exceeded supply limits allowed by the Act. These actions resulted in …
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)
… Fee-for-Service Payments for Pharmacy Services Covered by Managed Care (Report 2014-S-5 ). Background Our initial … recipients whose pharmacy benefits were covered by managed care. We recommended the Department review the …
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) were … The audit included all expenses claimed on Starting Point’s CFR for the fiscal year ended June 30, 2013, and …
https://www.osc.ny.gov/state-agencies/audits/2015/12/11/starting-point-services-children-compliance-reimbursable-cost-manual