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Medicaid Program – Managed Care Premium Payments for Recipients With Comprehensive Third-Party Insurance
… Managed Care Payments for Medicaid Recipients With Medicare (2010-S-75) Department of Health: Inappropriate …
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
… through December 31, 2016. Background The New York State Health Insurance Program (NYSHIP), administered by the State … testing, outpatient surgery, physical therapy, and home care services. United processes and pays claims from health …
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
… special education provider located in Nassau County, New York. SLCD provides preschool special education services to …
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
… Manual, including costs attributable to excessive space (square footage) allocations; $273,100 in ineligible … Compliance 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
… to children with disabilities who are between the ages of three and five years. During the 2014-15 school year, … served about 52 students. The New York City Department of Education (DoE) refers students to Lifeline and pays for … in ineligible expenses, including $21,083 in taxi fares to transport parents and their children to Lifeline for …
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
… costs, and if so, to quantify the overpayments made by United HealthCare resulting from this practice. The audit covered … Members pay a nominal co-payment to the participating provider for the services rendered. Members may also choose …
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
… Health paid pharmacy providers for controlled substances in compliance with the New York State Controlled Substances … or fax, due to the inherent risk of drugs ordered in this manner being diverted for inappropriate or … (MCOs) a monthly premium for each recipient enrolled in the MCO. The MCO then arranges for the provision of …
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 covered … Members pay a nominal co-payment to the participating provider for the services rendered. Members may also choose …
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)
… Fraudulent and Improper Claims Submitted by Davis Ethical Pharmacy (2012-S-11). Background Our initial audit report, … made improper payments totaling $94,460 to Davis Ethical Pharmacy. Based on information obtained from the prescribers … Fraudulent and Improper Claims Submitted by Davis Ethical Pharmacy (2012-S-11) United HealthCare Insurance Program: …
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
… premium for every Medicaid recipient enrolled in the MCO, and the MCO arranges for the provision of services its members … paid approximately $46.5 billion in premiums to 92 MCO plans. Key Findings Medicaid inappropriately paid 29,289 …
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)
… of implementation of the three recommendations included in our initial audit report, Educators for Children, Youth and Families, Inc. - Use of Contract … claims amounting to $1.8 million, out of $3.2 million in contract payments, to determine if the claims were …
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
… edits check various Department files to verify recipient eligibility, provider credentials, and medical necessity. … 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, the …
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
… was temporarily suspended to avoid interfering with a review by other external oversight authorities of some of the … inaccurate instructions for use; Claims wherein the drug and drug strength were different from what the physician … the providers to the State Education Department’s Office of the Professions. Other Related Audits/Reports 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
… water damage, structural damage, exposed wiring, missing smoke detectors, missing linens, and excessive garbage in rooms. In …
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
… are based on fixed fees, as opposed to the cost-based rates established through financial information reported on … students to St. Mary’s and pays for its services using rates established by SED. The rates are based on the … building violations, and vehicle expenses; $4,849 in valet parking services that were neither reasonable nor directly …
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)
… communities. MLTC plans offer a range of services, such as home health care, nursing home care, dentistry, vision care, and durable medical …
https://www.osc.ny.gov/state-agencies/audits/2021/08/31/improper-fee-service-payments-services-covered-managed-long-term-care-plans-followQuality Services for the Autism Community – Compliance With the Reimbursable Cost Manual
… is approved by SED to provide Preschool Special Education (SC) and Special Education Itinerant Teacher (SEIT) program … with autism between three and five years of age. Both the SC and SEIT programs are located in Douglaston, Queens. For … 2015, QSAC served 164 students, which consisted of 140 in SC and 32 in SEIT, with 8 children enrolled in both Programs. …
https://www.osc.ny.gov/state-agencies/audits/2019/12/31/quality-services-autism-community-compliance-reimbursable-cost-manualMedicaid Program – Improper Fee-for-Service Payments for Services Covered by Long-Term Care Plans
… of Health (Department) made improper fee-for-service (FFS) payments for certain services covered by managed … services. The Medicaid program should not pay claims on a FFS basis for services covered by MLTC plans. Individuals are … The audit identified $16.4 million in improper Medicaid FFS payments for MLTC covered services. The improper payments …
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
… To determine whether the costs reported by the Hebrew Academy for Special Children, Inc. (Hebrew Academy) on its Consolidated Fiscal Reports (CFRs) were … The audit focused primarily on expenses claimed on Hebrew Academy’s CFR for the fiscal year ended June 30, 2017 and …
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)
… the extent of implementation of the nine recommendations included in our initial audit report, Administration of the … contract and other related OMH contracts. These expenses included charges for a profit-sharing account that primarily … the extent of implementation of the nine recommendations included in our initial audit report Administration of the …
https://www.osc.ny.gov/state-agencies/audits/2020/09/15/administration-contract-postgraduate-center-mental-health-follow