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Starting Point Services for Children – Compliance With the Reimbursable Cost Manual
… 942 students. The New York City Department of Education (DoE) refers students to Starting Point based on clinical … 2013, Starting Point reported approximately $16.4 million in reimbursable costs for the audited programs. Our audit … fiscal years ended June 30, 2013, we identified $2,585,454 in reported costs that did not comply with Manual …
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
… whether UnitedHealthcare improperly paid for medical services designated with modifier code 59 that were not distinct and independent from other services provided on the same day. The audit covered the … to process and pay medical and surgical claims for services provided to Empire Plan members. United’s payments …
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
… whether the costs reported by the Milestone School for Child Development (Milestone) on its Consolidated Fiscal … The audit included all expenses claimed on Milestone’s CFR for the fiscal year 2012-13, and certain expenses claimed on Milestone’s CFRs for the two fiscal years ended June 30, 2012. Background The …
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
… Purpose We audited the New York City Department of Health and Mental Hygiene’s (DOHMH) administration of a contract (#113 225 01) with the Center for Urban … 1, 2010 through July 15, 2015. The audit included a review of costs claimed by CUCS and paid by DOHMH for the year ended …
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
… overpaid hospitals by reimbursing for higher levels of medical care than those actually provided to patients. The … March 31, 2010. Background Medicaid recipients in need of inpatient hospital care are provided a full range of necessary diagnostic, palliative and therapeutic care, …
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
… To determine whether the costs reported by All Services for Kids, Inc. (All Services) on its Consolidated Fiscal … To determine whether the costs reported by All Services for Kids Inc All Services on its Consolidated Fiscal Reports …
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
… Medicaid made improper Medicare premium payments on behalf of recipients enrolled in the Medicare buy-in program. The … to November 30, 2020. About the Program The Department of Health (Department) administers New York’s Medicaid … eligibility requirements. The State’s Local Departments of Social Services (Local Districts) determine eligibility …
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)
… included in our initial audit report, Overpayments for Therapy Services and Prescription Drugs Covered by Medicare … Medicare program covers physical, occupational, and speech therapy services as well as prescription drugs. When these … overpaid health care providers’ Medicaid claims for therapy services and prescription drugs that are covered by …
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
… of the lens in the eye – which cause vision problems. A cataract is corrected with surgery, which frequently involves removing the clouded lens and replacing it with an intraocular lens (such as a plastic lens). Empire generally reimburses the intraocular …
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)
… contracts with Health Management Systems, Incorporated (HMS) to identify and verify third-party coverages. HMS enters into data-sharing agreements with third-party … as an affiliate). We recommended the Department work with HMS to amend data-sharing agreements with third-party …
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)
… Objective To determine the extent of implementation of the three … recommendations included in our initial audit report, Opioid Prescriptions for Medicaid Recipients in an Opioid … an opioid use disorder. The State maintains a database to monitor controlled substance prescription drug use, known …
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)
To determine the extent of implementation of the five recommendations included in our initial audit report Medicaid Overpayments for Medicare Part B Services Billed Directly to eMedNY Report 2017S36
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). The audit covered the period … the Department of Health and Human Services in exchange for state Medicaid coverage of most of the manufacturer’s …
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)
… Objective To determine the extent of implementation of the five recommendations included in the initial audit … With Special Education Regulations for the Provision of Services (Report 2018-N-5 ). About the Program In New York … To determine the extent of implementation of the five recommendations included in the …
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
… to a hospital will increase. Medicaid will only pay for medical care and services that are medically necessary, whose … necessity is evident from documentation in the patient’s medical record, and that meet existing standards of … that contained a severe malnutrition diagnosis that the medical records did not appear to support. We found that the …
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
… To determine whether the costs reported by Northside Center for Child Development (Northside) on its Consolidated Fiscal … to the SC and SCIS programs. We also disallowed the Child Care Allowance because it was not proportionately … To determine whether the costs reported by Northside Center for Child Development Northside on its Consolidated …
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
… their members. The Medicaid program should not pay claims on a FFS basis when the services are covered by managed care. …
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)
… and/or excessive overtime costs. Additionally, video from surveillance cameras found that security officers …
https://www.osc.ny.gov/state-agencies/audits/2018/12/28/york-college-time-and-attendance-practices-public-safety-staff-followGASB Statement No. 33 "Accounting and Financial Reporting for Nonexchange Transactions"
… County, City, Town and Village Chief Fiscal Officers GASB Statement No. 33 provides accounting and reporting guidelines … between services provided and supporting revenues. The statement describes four categories of nonexchange … The purpose of this bulletin is to discuss the Statement No. 33 impact on revenue recognition when using the …
https://www.osc.ny.gov/local-government/publications/gasb-statement-no-33-accounting-and-financial-reporting-nonexchange-transactionsCity of Batavia – Awarding Contracts for Goods and Services (2013M-296)
… Purpose of Audit The purpose of our audit was to review the City’s purchasing process for … 1, 2012 through September 6, 2013. Background The City of Batavia is located in Genesee County and has a population … City of Batavia Awarding Contracts for Goods and Services 2013M296 …
https://www.osc.ny.gov/local-government/audits/city/2014/01/24/city-batavia-awarding-contracts-goods-and-services-2013m-296