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Medicaid Program – Managed Care Premium Payments for Recipients With Comprehensive Third-Party Insurance
… Health (Department) made Medicaid mainstream managed care premium payments on behalf of individuals who had … Medicaid pays managed care organizations (MCOs) a monthly premium for each enrolled Medicaid recipient, and the MCOs … paid about $1.28 billion in Medicaid managed care premium payments on behalf of enrollees who also had …
https://www.osc.ny.gov/state-agencies/audits/2018/06/13/medicaid-program-managed-care-premium-payments-recipients-comprehensive-third-partySchool for Language and Communication Development – Compliance With the Reimbursable Cost Manual
… provides preschool special education services to children with disabilities who are between three and five years of … be eligible for reimbursement, reported costs must comply with the RCM requirements. For the three fiscal years ended … Ensure that costs reported on annual CFRs fully comply with SED’s requirements, and communicate with SED to obtain …
https://www.osc.ny.gov/state-agencies/audits/2018/04/16/school-language-and-communication-development-compliance-reimbursable-cost-manualNew York Therapy Placement Services, Inc. – Compliance With the Reimbursable Cost Manual
… provides preschool special education services to children with disabilities who are between three and five years of … be eligible for reimbursement, reported costs must comply with the RCM’s requirements. For the three fiscal years ended … identified $841,392 in reported costs that did not comply with SED’s requirements, including $483,136 in personal …
https://www.osc.ny.gov/state-agencies/audits/2018/12/31/new-york-therapy-placement-services-inc-compliance-reimbursable-cost-manualBrookville Center for Children’s Services, Inc. – Compliance With the Reimbursable Cost Manual
… provide preschool special education services to children with disabilities between the ages of three and five years. … Chapter (AHRC), a related party, provided Brookville with management services under the Corporate and … $1,089,215 in reported costs that did not comply with the Manual’s requirements and recommend such costs be …
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
… provide preschool special education services to children with disabilities who are between the ages of three and five … cost-based program. Lifeline also shares space and staff with a DoE District 75 program that serves school-age special … identified $304,192 in reported costs that did not comply with the guidelines in the Manual, as follows: $80,506 in …
https://www.osc.ny.gov/state-agencies/audits/2017/10/12/lifeline-center-child-development-inc-compliance-reimbursable-cost-manualRiverbank State Park – Administration of the Concession Contract With Riverbank Restaurant Group
… services at Riverbank State Park operated by Riverbank Restaurant Group, LLC (RRG), for the period May 1, 2004 to …
https://www.osc.ny.gov/state-agencies/audits/2014/11/24/riverbank-state-park-administration-concession-contract-riverbank-restaurant-groupClinical Associates of the Finger Lakes – Compliance With the Reimbursable Cost Manual
… provides preschool special education services to children with disabilities between the ages of three and five years. … be eligible for reimbursement, reported costs must comply with the guidelines specified in the RCM. For the fiscal year … in costs charged to the SEIT program that did not comply with SED’s requirements for reimbursement. The disallowances …
https://www.osc.ny.gov/state-agencies/audits/2015/07/22/clinical-associates-finger-lakes-compliance-reimbursable-cost-manualInspire (Orange County Cerebral Palsy Association) – Compliance With the Reimbursable Cost Manual
… be eligible for reimbursement, reported costs must comply with RCM requirements. For the fiscal year ended June 30, … Ensure that costs reported on annual CFRs fully comply with SED’s requirements, and communicate with SED to obtain clarification as needed. Other Related …
https://www.osc.ny.gov/state-agencies/audits/2015/12/29/inspire-orange-county-cerebral-palsy-association-compliance-reimbursable-cost-manualJust Kids Early Childhood Learning Center – Compliance With the Reimbursable Cost Manual
… Several Just Kids employees also performed services at an affiliated entity, Just Kids Diagnostic & Treatment … the parents of the students enrolled in their programs; $70,951 for lack of time records/work product for an employee; …
https://www.osc.ny.gov/state-agencies/audits/2015/12/31/just-kids-early-childhood-learning-center-compliance-reimbursable-cost-manualMedicaid Program – Reducing Medicaid Costs for Recipients With End Stage Renal Disease
… to control the Medicaid costs of recipients diagnosed with end stage renal disease who were eligible for, but not … on behalf of 10,906 Medicaid recipients who were diagnosed with ESRD. Medicaid recipients with ESRD are eligible for Medicare coverage if they receive …
https://www.osc.ny.gov/state-agencies/audits/2017/03/01/medicaid-program-reducing-medicaid-costs-recipients-end-stage-renal-diseaseLittle Meadows Early Childhood Center, Inc. – Compliance With the Reimbursable Cost Manual
… Preschool Special Education services to children with disabilities who are between the ages of 3 and 5 years. … identified $395,644 in reported costs that did not comply with the requirements in the RCM and the CFR Manual, as … accounting fees and services that were not in compliance with the RCM’s requirements; $57,834 in expenses that were …
https://www.osc.ny.gov/state-agencies/audits/2022/07/07/little-meadows-early-childhood-center-inc-compliance-reimbursable-cost-manualSt. Mary’s Hospital for Children, Inc. – Compliance With the Reimbursable Cost Manual
… SED to provide full-day Special Class services to children with disabilities between the ages of 3 and 4 years. For the … be eligible for reimbursement, reported costs must comply with the RCM requirements. St. Mary’s also operates other … identified $257,142 in reported costs that did not comply with the requirements in the RCM and the CFR Manual, as …
https://www.osc.ny.gov/state-agencies/audits/2022/11/09/st-marys-hospital-children-inc-compliance-reimbursable-cost-manualThe Arc Erie County New York – Compliance With the Reimbursable Cost Manual
… provides preschool special education services to children with disabilities who are between 3 and 4 years of age. SED … to SED. Costs reported on the CFR must comply fully with the guidelines in SED’s RCM regarding eligibility and … that Arc Erie reported on its CFR that did not comply with SED’s requirements for reimbursement. The ineligible …
https://www.osc.ny.gov/state-agencies/audits/2022/12/06/arc-erie-county-new-york-compliance-reimbursable-cost-manualKids Unlimited, PT, OT & SLP, PLLC – Compliance With the Reimbursable Cost Manual
… whether the costs reported by Kids Unlimited, PT, OT & SLP, PLLC (Kids Unlimited) on its Consolidated Fiscal Reports … whether the costs reported by Kids Unlimited PT OT SLP PLLC on its Consolidated Fiscal Reports were reasonable …
https://www.osc.ny.gov/state-agencies/audits/2020/12/31/kids-unlimited-pt-ot-slp-pllc-compliance-reimbursable-cost-manualQuality Services for the Autism Community – Compliance With the Reimbursable Cost Manual
… non-profit organization that supports children and adults with autism. QSAC’s administrative office for all programs is … Itinerant Teacher (SEIT) program services to children with autism between three and five years of age. Both the SC … 164 students, which consisted of 140 in SC and 32 in SEIT, with 8 children enrolled in both Programs. QSAC has 13 SC …
https://www.osc.ny.gov/state-agencies/audits/2019/12/31/quality-services-autism-community-compliance-reimbursable-cost-manualBehavior Analysts of New York, LLC – Compliance With the Reimbursable Cost Manual
… calculated, and adequately documented in accordance with applicable State Education Department (SED) … of preschool special education services to children with disabilities who are between three and five years of … be eligible for reimbursement, reported costs must comply with SED’s Reimbursable Cost Manual (RCM) requirements. For …
https://www.osc.ny.gov/state-agencies/audits/2020/01/31/behavior-analysts-new-york-llc-compliance-reimbursable-cost-manualHebrew Academy for Special Children, Inc. – Compliance With the Reimbursable Cost Manual
… Class in an Integrated Setting (SCIS) programs to children with disabilities who are between the ages of three and five … of Health, programs funded through the Office for People With Developmental Disabilities, a camp, and a day care … $2,873,898 in reported costs that did not comply with the requirements in the RCM and the Consolidated Fiscal …
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)
… of the Contract With the Postgraduate Center for Mental Health ( 2015-S-88 ). About the Program Our initial … issued December 30, 2016, determined if the Office of Mental Health (OMH) effectively administered its Supportive … Housing Contract with the Postgraduate Center for Mental Health (PCMH). The audit found sampled clients were …
https://www.osc.ny.gov/state-agencies/audits/2020/09/15/administration-contract-postgraduate-center-mental-health-followUCP of Niagara County d.b.a. Empower – Compliance With the Reimbursable Cost Manual
… Special Class – over 2.5 hours per day—to children with disabilities up to the age of 5 years. Empower is an … $1,141,685 in reported costs that did not comply with the requirements in the RCM and CFR Manual, as follows: … $2,157 in bonus payment compensation that did not comply with the RCM. Key Recommendations To SED: Review the …
https://www.osc.ny.gov/state-agencies/audits/2024/06/21/ucp-niagara-county-dba-empower-compliance-reimbursable-cost-manualMedicaid Program – Improper Fee-for-Service Pharmacy Payments for Recipients With Third-Party Health Insurance
… FFS pharmacy providers are required to coordinate benefits with the recipient’s TPHI prior to billing Medicaid for … Office of the Medicaid Inspector General (OMIG) contracts with Gainwell Technologies (Gainwell) to identify and recover … by comparing claims Medicaid paid for recipients with TPHI drug coverage to claims reviewed and recovered by …
https://www.osc.ny.gov/state-agencies/audits/2023/05/11/medicaid-program-improper-fee-service-pharmacy-payments-recipients-third-party-health