Search
Medicaid Program – Inappropriate Premium Payments for Recipients No Longer Enrolled in Mainstream Managed Care and Family Health Plus
… the Department of Health (Department) made inappropriate premium payments to Medicaid mainstream managed care plans … care arrangements, managed care plans receive monthly premium payments for individuals enrolled in their plans. In … Department paid Plans approximately $94 billion in monthly premium payments. The Department can recover inappropriate …
https://www.osc.ny.gov/state-agencies/audits/2017/07/11/medicaid-program-inappropriate-premium-payments-recipients-no-longer-enrolled-mainstreamMedicaid Program – Ambulatory Patient Groups Payments for Duplicate Claims and Services in Excess of Medicaid Service Limits (Follow-Up)
… Purpose To determine the implementation status of the six recommendations made in our initial audit report, … Payments for Duplicate Claims and Services in Excess of Medicaid Service Limits (Report 2013-S-17 ). Background We … audit objective was to determine whether the Department of Health (Department) had established adequate controls to …
https://www.osc.ny.gov/state-agencies/audits/2017/10/06/medicaid-program-ambulatory-patient-groups-payments-duplicate-claims-and-services-excessAssessment of Costs to Administer the Workers’ Compensation Program for the Two Fiscal Years Ended March 31, 2013
… and self-insured political subdivisions of the State. Key Findings The Board has adequate procedures in …
https://www.osc.ny.gov/state-agencies/audits/2015/04/15/assessment-costs-administer-workers-compensation-program-two-fiscal-years-ended-march-31Motor Vehicle Financial Security and Safety Responsibility Acts – Assessable Expenses for the Fiscal Year Ended March 31, 2014
… Purpose The purpose of this performance audit was to determine whether the Department of Motor Vehicles (Department) has adequate procedures in place to accurately report its assessable expenses incurred in … Vehicle and Traffic Law. We performed our audit pursuant to legislative mandates included in these statutes, which …
https://www.osc.ny.gov/state-agencies/audits/2015/04/15/motor-vehicle-financial-security-and-safety-responsibility-acts-assessable-expenses-fiscalSelected Payments for Special Items Made to Stony Brook University Hospital from January 1, 2011 through March 31, 2011
… Purpose To determine if Empire BlueCross BlueShield's (Empire's) payments to State University of New York's Stony Brook University … To determine if Empire BlueCross BlueShields Empires payments …
https://www.osc.ny.gov/state-agencies/audits/2013/02/01/selected-payments-special-items-made-stony-brook-university-hospital-january-1-2011-throughSelected Payments for Special Items Made to St. Luke's Cornwall Hospital from January 1, 2011 through March 31, 2011
… determine if BlueCross BlueShield's (Empire's) payments to St. Luke's Cornwall Hospital (St. Luke's) for special items were made according to the provisions of the agreement between Empire and St. Luke's. Background The New York State Health Insurance …
https://www.osc.ny.gov/state-agencies/audits/2013/02/01/selected-payments-special-items-made-st-lukes-cornwall-hospital-january-1-2011-throughSelected Payments for Special Items Made to Mary Imogene Bassett Hospital from January 1, 2011 through March 31, 2011
… Purpose To determine if BlueCross BlueShield’s (Empire’s) payments to Mary Imogene Bassett Hospital (Bassett) for special items … To determine if BlueCross BlueShields Empires payments to Mary Imogene Bassett Hospital Bassett for special items …
https://www.osc.ny.gov/state-agencies/audits/2013/02/01/selected-payments-special-items-made-mary-imogene-bassett-hospital-january-1-2011-throughMedicaid Program – Excessive Premium Payments for Dual-Eligible Recipients Enrolled in Mainstream Managed Care and Health and Recovery Plans
… Objective To determine whether Medicaid overpaid Mainstream Managed … recipients are enrolled in Medicare and are referred to as “dual-eligibles.” Additionally, many of the State’s … and Recovery Plans (HARP), which provide specialized care to recipients aged 21 or older with serious mental illness …
https://www.osc.ny.gov/state-agencies/audits/2022/10/31/medicaid-program-excessive-premium-payments-dual-eligible-recipients-enrolled-mainstreamAccounting and Financial Reporting for Subscription-Based Information Technology Arrangements (SBITAs) as Required by GASB Statement No. 96
The purpose of this bulletin is to provide accounting and financial reporting guidance for subscription-based information technology arrangements (SBITAs) and illustrate how local governments and school districts will need to account for and report these SBITAs in the Annual Financial Report (AFR)
https://www.osc.ny.gov/files/local-government/publications/pdf/accounting-bulletin-gasb-96.pdfMedicaid Program: Improper Fee-for-Service Pharmacy Payments for Recipients With Third-Party Health Insurance (2021-S-20) 180-Day Response
To determine if Medicaid made inappropriate fee-for-service payments to pharmacies on behalf of recipients who had third-party insurance and, if so, whether appropriate recoveries were made.
https://www.osc.ny.gov/files/state-agencies/audits/pdf/sga-2023-21s20-response.pdfImproper Medicaid Payments for Claims Not in Compliance With Ordering, Prescribing, Referring, and Attending Requirements (Follow-Up) (2023-F-4)
To assess the extent of implementation of the 12 recommendations included in our initial audit report, Improper Medicaid Payments for Claims Not in Compliance With Ordering, Prescribing, Referring, and Attending Requirements (Report 2019-S-2).
https://www.osc.ny.gov/files/state-agencies/audits/pdf/sga-2023-23f4.pdfRecovering Managed Care Payments for Inpatient Services on Behalf of Recipients With Third-Party Health Insurance (2021-S-24)
To determine whether Medicaid overpayments for inpatient services on behalf of managed care recipients who had third-party health insurance were appropriately recovered.
https://www.osc.ny.gov/files/state-agencies/audits/pdf/sga-2023-21s24.pdfImproper Medicaid Payments for Individuals Receiving Hospice Services Covered by Medicare (Follow-Up) (2022-F-31) 30-Day Response
To assess the extent of implementation of the nine recommendations included in our initial audit report, Improper Medicaid Payments for Individuals Receiving Hospice Services Covered by Medicare (Report 2018-S-71).
https://www.osc.ny.gov/files/state-agencies/audits/pdf/sga-2023-22f31-response.pdfThe Importance of Responsible Debt Management: Poor State Bond Structuring Choices Lead to Greater Costs for Taxpayers
In the throes of the economic uncertainty and fiscal turbulence caused by the COVID crisis, legislation was enacted as part of the SFY 2021-22 budget authorizing the use of State-supported bonding with final maturities up to 50 years for capital purposes for the MTA.
https://www.osc.ny.gov/files/reports/pdf/importance-of-responsible-debt-management.pdfRecovering Managed Care Overpayments for Pharmacy Services on Behalf of Recipients With Third-Party Health Insurance (2020-S-39)
To determine whether Medicaid overpayments for pharmacy services on behalf of managed care recipients who had third-party health insurance were appropriately recovered.
https://www.osc.ny.gov/files/state-agencies/audits/pdf/sga-2022-20s39.pdfLife Skills Home Training Tutorial Program for Preschoolers, Inc.: Compliance With the Reimbursable Cost Manual (2020-S-37)
To determine whether the costs reported by Life Skills Home Training Tutorial Program for Preschoolers, Inc. on its Consolidated Fiscal Reports were reasonable, necessary, directly related to the special education programs, and sufficiently documented pursuant to the State Education Department's ...
https://www.osc.ny.gov/files/state-agencies/audits/pdf/sga-2022-20s37-response.pdfEye Care Provider and Family Inappropriately Enroll as Recipients and Overcharge for Vision Services (Follow-Up) (2017-F-11)
To determine the implementation status of the eight recommendations in our initial audit report, Eye Care Provider and Family Inappropriately Enroll as Recipients and Overcharge for Vision Services (Report 2013-S-1) ...
https://www.osc.ny.gov/files/state-agencies/audits/pdf/sga-2017-17f11.pdfAmbulatory Patient Groups Payments for Duplicate Claims and Services in Excess of Medicaid Service Limits (Follow-Up) (2017-F-3)
To determine the implementation status of the six recommendations made in our initial audit report, Ambulatory Patient Groups Payments for Duplicate Claims and Services in Excess of Medicaid Service Limits (Report 2013-S-17).
https://www.osc.ny.gov/files/state-agencies/audits/pdf/sga-2017-17f3.pdfQuestionable Payments for Practitioner Services and Pharmacy Claims Pertaining to a Selected Physician (Follow-Up) (2017-F-2) 30-Day Response
To determine the implementation status of the four recommendations made in our initial audit report, Questionable Payments for Practitioner Services and Pharmacy Claims Pertaining to a Selected Physician.
https://www.osc.ny.gov/files/state-agencies/audits/pdf/sga-2017-17f2-response.pdfMedicaid Program - Improper Medicaid Payments Involving Fee-for-Service Claims for Recipients With Multiple Client Identification Numbers (2019-S-22)
To determine if improper Medicaid payments were made on behalf of recipients with multiple Client Identification Numbers (CINs) ...
https://www.osc.ny.gov/files/state-agencies/audits/pdf/sga-2020-19s22.pdf