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New Contracts Eligibility Determination

Provides guidance for State authorities to identify new contracts that must be submitted to OSC for filing or for prior approval.

New York State Health Insurance Program - Payments by CVS Health for Pharmacy Services for Ineligible Members (Follow-Up) (2022-F-29)

To assess the extent of implementation of the six recommendations included in our initial audit report, Payments by CVS Health for Pharmacy Services for Ineligible Members (Report 2020-S-17).

New York State Health Insurance Program – Payments by Empire BlueCross for Hospital Services for Ineligible Members (Follow-Up) (2021-F-17)

To assess the extent of implementation of the five recommendations included in our initial audit report, Payments by Empire BlueCross for Hospital Services for Ineligible Members (Report 2019-S-32).

State Agencies Bulletin No. 1090

To inform agencies of changes to the meaning and usage of some of the data elements in PayServ related to the implementation of the Statewide Financial System

West Corners Fire Company – Accounting for Cash Receipts and Disbursements (2014M-215)

… ensured that the Treasurer was properly accounting for cash receipts and disbursements for the period January 1, 2013 through May 16, 2014. … that is located in, and provides fire protection services for, the Town of Union in Broome County. The Company’s …

DiNapoli: State Pays Drug Treatment Center Nearly $4 Million for Ineligible Expenses

… $3.9 million in ineligible payments due to the processing of invalid claims and inadequate oversight by the state Office of Alcoholism and Substance Abuse Services (OASAS), according … to,” said DiNapoli. “Our audit revealed that millions of dollars were claimed and spent on ineligible costs. …

DiNapoli Audit Highlights Need for Better Compliance with School Violence Reporting Law

… (SED) has agreed to improve its enforcement of the Safe Schools Against Violence in Education Act (SAVE Act) after a state audit found schools failed to report numerous cases of … in 2000 to boost school safety and address violence in our public schools,” DiNapoli said. “Unfortunately, it appears …

Monitoring of Not-for-Profit Cemeteries for Fiscal Stability and Adequate Facility Maintenance (Follow-Up)

… of implementation of the four recommendations included in our initial audit report, Monitoring of Not-for-Profit … for all not-for-profit cemetery corporations (cemeteries) in New York State. As authorized by Article 15 of the … 2016, 391 cemeteries (22 percent) had not been inspected in over seven years. Weaknesses in data integrity, entry, and …

Medicaid Program – Opioid Prescriptions for Medicaid Recipients in an Opioid Treatment Program

… determine if the Department of Health has taken sufficient steps to safeguard Medicaid recipients who are receiving … 1,065 prescriptions (6 percent). Key Recommendations Take steps to ensure Treatment Programs appropriately check I-STOP. Evaluate steps to improve scrutiny over opioid prescriptions for …

Medicaid Program – Medicaid Overpayments for Medicare Part B Services Billed Directly to eMedNY

… for Part B deductibles that exceeded dual-eligibles’ yearly limits. Key Recommendations Review the payments …

School for Language and Communication Development – Compliance With the Reimbursable Cost Manual

… with disabilities who are between three and five years of age. SLCD is reimbursed for preschool special education … SLCD’s tuition reimbursement rates. Remind SLCD officials of the pertinent SED requirements that relate to the … Compliance With the Reimbursable Cost Manual ( 2016-S-74 ) Kennedy Child Study Center: Compliance With the Reimbursable …

UnitedHealthcare – Overpayments for Out-of-Network Anesthesia Services Provided at In-Network Ambulatory Surgery Centers

… Purpose To determine whether UnitedHealthcare overpaid for out-of-network anesthesia services provided at Ambulatory … The Empire Plan is the primary health benefits plan for NYSHIP. The Empire Plan provides its members with four … processes and pays claims from health care providers for services provided to Empire Plan members, and Civil …

Children’s Unit for Treatment and Evaluation – Compliance With the Reimbursable Cost Manual

… June 30, 2015. About the Program CUTE, an SED-approved provider located in Broome County, New York, provides preschool special education services to …

Educators for Children, Youth and Families, Inc. – Use of Contract Funds (Follow-Up)

… included in our initial audit report, Educators for Children, Youth and Families, Inc. - Use of Contract Funds (Report … Department (SED) and the Office of Children and Family Services (OCFS) under grant contracts for the period July 1, …

Sheriffs, Undersheriffs and Deputy Sheriffs Special Plan for ERS Tier 3, 4, 5 and 6 Members – Sheriffs, Undersheriffs and Deputy Sheriffs Special Plan for ERS Tier 3, 4, 5 and 6 Members

Sheriffs, Undersheriffs and Deputy Sheriffs Special Plan for ERS Tier 1 and 2 Members – Sheriffs, Undersheriffs and Deputy Sheriffs Special Plan for ERS Tier 1 and 2 Members

Medicaid Program – Managed Care Premium Payments for Recipients With Comprehensive Third-Party Insurance

… the New York State Social Services Law, the Department’s policy is to exclude Medicaid recipients from mainstream … Furthermore, according to the Medicaid Managed Care Model Contract, when the Medicaid managed care provider and … we identified and recover as appropriate. Amend the Model Contract language to allow the Department to recover …

UnitedHealthcare – 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 … Service (Department) contracts 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 …

Changes in Federal Policies Pose Significant Risks for New York City's Budget

… Projected budget gaps for New York City in the coming years appear manageable, but tax changes and … by State Comptroller Thomas P. DiNapoli. "Major shifts in federal fiscal policies constitute the greatest risk to … may lie ahead, depending on the effects of what happens in Washington." The November update to the city’s four-year …

Medicaid Program – Medicaid Payments for Pharmacy Claims: Joia Pharmacy and a Related Prescriber

… to matters addressing the Doctor’s prescribing activity for the period January 1, 2013 through June 30, 2016. Background The Department is responsible for administering New York State’s Medicaid program. Medicaid … disadvantaged and/or have special health care needs. For the State fiscal year ended March 31, 2016, New York’s …