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DiNapoli: Former Clerk Treasurer for the Village of Speculator Charged With Larceny
… 25 before Judge Gordon L. Purdy II. She is due back at the Lake Pleasant Town Court on April 28, 2020. New Yorkers can … by filing a complaint online at investigations@osc.ny.gov , or by mailing a complaint to: Office of the State … of Investigations, 8th Floor, 110 State St., Albany, NY 12236. …
https://www.osc.ny.gov/press/releases/2020/02/dinapoli-former-clerk-treasurer-village-speculator-charged-larcenyAdministration of the CityFHEPS Program for Department of Homeless Services Shelter Residents
… To determine whether the NYC Department of Social Services is administering the City …
https://www.osc.ny.gov/state-agencies/audits/2024/10/30/administration-cityfheps-program-department-homeless-services-shelter-residentsNew York Institute for Special Education – Compliance With the Reimbursable Cost Manual
… and the Consolidated Fiscal Reporting and Claiming Manual (CFR Manual). The audit focused primarily on expenses claimed on the Institute’s CFR for the fiscal year ended June 30, 2020 and certain … did not comply with the requirements in the RCM and the CFR Manual, as follows: $3,132,751 in unsupported …
https://www.osc.ny.gov/state-agencies/audits/2024/12/18/new-york-institute-special-education-compliance-reimbursable-cost-manualMedicaid Program – Medicaid Payments for Early Refills of Prescription Drugs and Supplies
… appropriately. According to the New York Medicaid Pharmacy Manual, a pharmacy claim will be paid when more than 75% of … over the previous 90 days (the more stringent rule will apply). To prevent stockpiling and potential misuse of … continually allowed to bypass edits, the supply on hand can grow excessively high. In response to our findings, DOH …
https://www.osc.ny.gov/state-agencies/audits/2026/03/20/medicaid-program-medicaid-payments-early-refills-prescription-drugs-and-suppliesUnitedHealthcare – Improper Payments for Medical Services Designated By Modifier Code 59 (Follow-Up)
… Code 59 (Report 2013-S-82 ). Background The New York State Health Insurance Program (NYSHIP) provides health insurance coverage to active and retired State, … and their dependents. The Empire Plan is the primary health benefits plan for NYSHIP. The New York State …
https://www.osc.ny.gov/state-agencies/audits/2017/12/27/unitedhealthcare-improper-payments-medical-services-designated-modifier-code-59-followMedicaid Program – Managed Care Premium Payments for Recipients With Comprehensive Third-Party Insurance
… of Health (Department) made Medicaid mainstream managed care premium payments on behalf of individuals who had … funded program that provides a wide range of health care services to those who are economically disadvantaged and/or have special health care needs. The Department administers the State’s Medicaid …
https://www.osc.ny.gov/state-agencies/audits/2018/06/13/medicaid-program-managed-care-premium-payments-recipients-comprehensive-third-partyUnitedHealthcare – Overpayments for Out-of-Network Anesthesia Services Provided at In-Network Ambulatory Surgery Centers
… employees, as well as their dependents. The Empire Plan is the primary health benefits plan for NYSHIP. The Empire …
https://www.osc.ny.gov/state-agencies/audits/2018/08/13/unitedhealthcare-overpayments-out-network-anesthesia-services-provided-network-ambulatorySchool for Language and Communication Development – Compliance With the Reimbursable Cost Manual
… Purpose To determine whether the costs reported by the School for Language and Communication Development (SLCD) on … To determine whether the costs reported by the School for Language and Communication Development on its …
https://www.osc.ny.gov/state-agencies/audits/2018/04/16/school-language-and-communication-development-compliance-reimbursable-cost-manualBrookville Center for Children’s Services, Inc. – Compliance With the Reimbursable Cost Manual
… With the Reimbursable Cost Manual ( 2015-S-19 ) New York League for Early Learning, Inc.: Compliance With the …
https://www.osc.ny.gov/state-agencies/audits/2017/10/04/brookville-center-childrens-services-inc-compliance-reimbursable-cost-manualLifeline Center for Child Development, Inc. – Compliance With the Reimbursable Cost Manual
… ended June 30, 2014. Background Lifeline is a Queens, New York-based not-for-profit organization authorized by SED to … food for Board meetings, $228 for student clothing, a $122 plaque for a retiring employee, and $56 for flowers; Lifeline …
https://www.osc.ny.gov/state-agencies/audits/2017/10/12/lifeline-center-child-development-inc-compliance-reimbursable-cost-manualUnited HealthCare – Overpayments for Services Provided by Orthopedic Associates of Long Island
… The New York State Department of Civil Service contracts with United HealthCare (United) to process and pay medical … services provided to Empire Plan members. United contracts with in-network participating providers who agree to accept … Overpayments for Services at the Capital Region Ambulatory Surgery Center (2007-S-72) New York State Health Insurance …
https://www.osc.ny.gov/state-agencies/audits/2016/05/05/united-healthcare-overpayments-services-provided-orthopedic-associates-long-islandMedicaid Program – Improper Payments for Controlled Substances That Exceed Allowed Dispensing Limits
… that exceed supply limits allowed by the Act. There is considerable risk that other participating Medicaid MCOs …
https://www.osc.ny.gov/state-agencies/audits/2015/02/06/medicaid-program-improper-payments-controlled-substances-exceed-allowed-dispensing-limitsUnited HealthCare – Overpayments for Services Provided by Eastern Orange Ambulatory Surgery Center
… costs, and if so, to quantify the overpayments made by United HealthCare resulting from this practice. The audit … 1, 2011 through March 31, 2015. Background The New York State Health Insurance Program (NYSHIP) provides health … New York State Department of Civil Service contracts with United HealthCare (United) to process and pay medical claims …
https://www.osc.ny.gov/state-agencies/audits/2016/05/05/united-healthcare-overpayments-services-provided-eastern-orange-ambulatory-surgery-centerPayments for Fraudulent and Improper Claims Submitted by Davis Ethical Pharmacy (Follow-Up)
… Department of Financial Services. On December 10, 2015, William Davis pleaded guilty to Grand Larceny in the Second … we did not test, and formally assess the conduct of William Davis. Key Finding Department officials made progress … initial audit report. At the time of our follow-up review, William Davis made full restitution of $231,919 to the State, …
https://www.osc.ny.gov/state-agencies/audits/2016/02/18/payments-fraudulent-and-improper-claims-submitted-davis-ethical-pharmacy-followMedicaid Program – Improper Fee-for-Service Payments for Pharmacy Services Covered by Managed Care
… for pharmacy services covered by recipients’ managed care plans. The audit covered the period October 1, 2011 … are economically disadvantaged and/or have special health care needs. In general, the Medicaid program pays medical … through either the fee-for-service method or the managed care plan method. Under the feefor- service method, Medicaid …
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)
… in our initial audit report, Educators for Children, Youth and Families, Inc. - Use of Contract Funds (Report … August 20, 2010, examined whether Educators for Children, Youth and Families, Inc. (Educators) appropriately used State … of Children and Family Services: Educators for Children, Youth and Families, Inc. - Use of Contract Funds (2007-S-128) …
https://www.osc.ny.gov/state-agencies/audits/2013/08/13/educators-children-youth-and-families-inc-use-contract-funds-followMedicaid Program – Improper Payments for Ancillary Services Provided During Hospital Inpatient Admissions
… for review. Medicaid reimbursement rates for inpatient hospital claims include the costs of most medical care provided during a hospital admission. As such, claims for ancillary services provided during a hospital admission are generally not reimbursable. In 2007, …
https://www.osc.ny.gov/state-agencies/audits/2014/04/03/medicaid-program-improper-payments-ancillary-services-provided-during-hospital-inpatientMedicaid Program – Medicaid Payments for Pharmacy Claims: Joia Pharmacy and a Related Prescriber
… Pharmacy, was a privately owned pharmacy located in Lower Manhattan. Soho Pharmacy was still in business at the time of …
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
… percent) are located in areas outside of New York City (NYC). Counties throughout the State utilize hotels and motels … are no formal shelters. Of the 57 counties outside of NYC, 24 (42 percent) do not have a dedicated shelter … with sufficient guidance about corrective action plans to address unsatisfactory conditions. Material aspects of OTDA’s …
https://www.osc.ny.gov/state-agencies/audits/2017/06/27/oversight-hotels-and-motels-used-homeless-and-mixed-use-temporary-residencyMedicaid Program – Reducing Medicaid Costs for Recipients With End Stage Renal Disease
… renal disease who were eligible for, but not enrolled in, Medicare. The audit covered the period January 1, 2010 … with ESRD. Medicaid recipients with ESRD are eligible for Medicare coverage if they receive regular dialysis treatments … the federal Social Security Administration (SSA) has a policy that allows Medicaid recipients who are age 65 and …
https://www.osc.ny.gov/state-agencies/audits/2017/03/01/medicaid-program-reducing-medicaid-costs-recipients-end-stage-renal-disease