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Medicaid Program – Ambulatory Patient Groups Payments for Duplicate Claims and Services in Excess of Medicaid Service Limits
… Purpose To determine whether the Department of Health established adequate controls to prevent duplicate … services using the APG payment methodology. The Department of Health (Department) adopted the APG methodology in an … are reimbursed based on patient condition and complexity of service. The Department phased in the APG methodology …
https://www.osc.ny.gov/state-agencies/audits/2015/06/29/medicaid-program-ambulatory-patient-groups-payments-duplicate-claims-and-services-excessMedicaid Program – Improper Payments for Recipients No Longer Enrolled in Managed Long Term Care Partial Capitation Plans
… Appropriateness of Medicaid Eligibility Determined by the New York State of Health System (2014-S-4) Department of …
https://www.osc.ny.gov/state-agencies/audits/2016/03/30/medicaid-program-improper-payments-recipients-no-longer-enrolled-managed-long-term-careSelected Payments for Special Items Made to Arden Hill Hospital From January 1, 2011 Through March 31, 2011
… special items were made according to the provisions of the ag …
https://www.osc.ny.gov/state-agencies/audits/2013/02/01/selected-payments-special-items-made-arden-hill-hospital-january-1-2011-through-march-31Selected Payments for Special Items Made to St. Mary's Hospital from January 1, 2011 through March 31, 2011
… special items were made according to the provisions of the ag …
https://www.osc.ny.gov/state-agencies/audits/2013/02/01/selected-payments-special-items-made-st-marys-hospital-january-1-2011-through-march-31-2011Selected Payments for Special Items Made to Albany Medical Center from January 1, 2011 through March 31, 2011
… (Empire’s) payments to Albany Medical Center (AMC) for special items were made according to the provisions of … The Empire Plan (Plan) is the primary health benefits plan for NYSHIP. The Department of Civil Service contracts with … portion of the Plan. Empire processes Plan claims for hospital services in accordance with agreements they …
https://www.osc.ny.gov/state-agencies/audits/2013/02/01/selected-payments-special-items-made-albany-medical-center-january-1-2011-through-march-31Selected Payments for Special Items Made to Mount Sinai Hospital from January 1, 2011 through March 31, 2011
… (Empire's) payments to Mount Sinai Hospital (Mount Sinai) for special items were made according to the provisions of … The Empire Plan (Plan) is the primary health benefits plan for NYSHIP. The Department of Civil Service contracts with … portion of the Plan. Empire processes Plan claims for hospital services in accordance with agreements they …
https://www.osc.ny.gov/state-agencies/audits/2013/02/01/selected-payments-special-items-made-mount-sinai-hospital-january-1-2011-through-march-31Selected Payments for Special Items Made to St. Peter's Hospital from January 1, 2011 through March 31, 2011
… determine if BlueCross BlueShield's (Empire's) payments to St. Peter's Hospital (St. Peter's) for special items were made according to the provisions of the agreement between Empire and St. Peter'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-peters-hospital-january-1-2011-through-march-31Assessment of Costs to Administer the Workers’ Compensation Program for the Fiscal Year Ended March 31, 2014
… Compensation Board (Board) has adequate procedures in place to accurately report its assessable expenses related … our audit pursuant to legislative mandates included in these statutes, which direct the Comptroller and the Chair … Board to ascertain the annual amount of expenses incurred in the administration of these Laws. Our audit covered the …
https://www.osc.ny.gov/state-agencies/audits/2016/10/26/assessment-costs-administer-workers-compensation-program-fiscal-year-ended-march-31-2014Identifying, Reporting, and Providing Services for Youth at Risk of Sexual Human Trafficking in New York City
… of sex-trafficked victims or at-risk youth reported under LL 41 between January 1, 2017 and December 31, 2020. ACS and …
https://www.osc.ny.gov/state-agencies/audits/2022/06/06/identifying-reporting-and-providing-services-youth-risk-sexual-human-trafficking-new-yorkMedicaid Program – Recovering Managed Care Overpayments for Pharmacy Services on Behalf of Recipients With Third-Party Health Insurance
… Medicaid overpayments for pharmacy services on behalf of managed care recipients who had third-party health … 2015 through May 2020. About the Program The Department of Health (Department) administers New York’s Medicaid program. Many of the State’s Medicaid recipients receive their services …
https://www.osc.ny.gov/state-agencies/audits/2022/07/13/medicaid-program-recovering-managed-care-overpayments-pharmacy-services-behalf-recipientsNew York City Department of Homeless Services – Oversight of Contract Expenditures of Institute for Community Living, Inc.
… must comply with DHS’ Human Service Providers Fiscal Manual (Fiscal Manual), the New York City Health and Human Services Cost Policies and Procedures Manual (Cost Manual), and the Tillary contract. Key Findings …
https://www.osc.ny.gov/state-agencies/audits/2022/09/16/new-york-city-department-homeless-services-oversight-contract-expenditures-instituteSelected Aspects of Leasing Practices for Real Estate Department, Aviation, World Trade Center, and Leasing of Properties
… Objectives To determine whether the Port Authority of New York and New Jersey (PANYNJ) collected all revenues … and whether PANYNJ followed its procedures in the leasing of properties. This audit covered the period January 1, 2014 … PANYNJ was created to promote and protect the commerce of the Port District – a region within approximately a …
https://www.osc.ny.gov/state-agencies/audits/2021/05/04/selected-aspects-leasing-practices-real-estate-department-aviation-world-trade-center-andMedicaid Program – Improper Medicaid Payments for Claims Not in Compliance With Ordering, Prescribing, Referring, and Attending Requirements
… that require an appropriate National Provider Identifier (NPI) for ordering, prescribing, referring, and attending … for Medicaid claims that did not contain an appropriate NPI in the OPRA fields and resulted in: $1.5 billion in … that did not contain an appropriate referring or attending NPI (for example, some claims contained NPIs of providers who …
https://www.osc.ny.gov/state-agencies/audits/2021/08/17/medicaid-program-improper-medicaid-payments-claims-not-compliance-ordering-prescribingInappropriate Premium Payments for Recipients No Longer Enrolled in Mainstream Managed Care and Family Health Plus (Follow-Up)
… Recipients No Longer Enrolled in Mainstream Managed Care and Family Health Plus (Report 2015-S-47 ). About the Program … This program was eliminated effective January 1, 2015 and the majority of FHP enrollees transitioned to the … premium payments to Medicaid mainstream managed care plans and FHP managed care plans for recipients who were no longer …
https://www.osc.ny.gov/state-agencies/audits/2020/02/25/inappropriate-premium-payments-recipients-no-longer-enrolled-mainstream-managed-care-andExcessive Premium Payments for Dual-Eligible Recipients Enrolled in Mainstream Managed Care and Health and Recovery Plans (Follow-Up)
… (Report 2021-S-37 ). About the Program DOH administers New York’s Medicaid program. Many Medicaid recipients are … recipients who became dual-eligible prior to the date the new IB-Dual rate became effective. Key Findings DOH officials …
https://www.osc.ny.gov/state-agencies/audits/2024/05/08/excessive-premium-payments-dual-eligible-recipients-enrolled-mainstream-managed-care-andMedicaid Program – Recovering Managed Care Payments for Inpatient Services on Behalf of Recipients With Third-Party Health Insurance
… Medicaid overpayments for inpatient services on behalf of managed care recipients who had third-party health … 2017 through August 2021. About the Program The Department of Health (Department) administers New York’s Medicaid program. Many of the State’s Medicaid recipients receive their services …
https://www.osc.ny.gov/state-agencies/audits/2023/09/27/medicaid-program-recovering-managed-care-payments-inpatient-services-behalf-recipientsDiNapoli: 33.55 Percent Annual Investment Return for New York State Pension Fund Is Largest in Its History
… estimated overall investment return was 33.55 percent for the state fiscal year (SFY) that ended March 31, 2021, … results that ensure continued retirement security for our members for generations to come.” The Fund's value reflects … Funds estimated overall investment return was 3355 percent for the state fiscal year that ended March 31 2021 reflecting …
https://www.osc.ny.gov/press/releases/2021/05/dinapoli-33-point-55-percent-annual-investment-return-new-york-state-pension-fund-largest-its-historyNYS Comptroller DiNapoli and Church of England Call on ExxonMobil to Set Targets for Lowering GHG Emissions
… Presbyterian Church USA and SHARE on behalf of Fonds de Solidarité des Travailleurs du Québec (FTQ). The full text …
https://www.osc.ny.gov/press/releases/2018/12/nys-comptroller-dinapoli-and-church-england-call-exxonmobil-set-targets-lowering-ghg-emissionsUnitedHealthcare Insurance Company of New York: Improper Payments for Acupuncture and Acupuncture-Related Services (Follow-Up) (2023-F-14)
To determine the extent of implementation of the four recommendations included in our initial audit report, New York State Health Insurance Program – UnitedHealthcare Insurance Company of New York: Improper Payments for Acupuncture and Acupuncture-Related Services (Report 2020-S-7).
https://www.osc.ny.gov/files/state-agencies/audits/pdf/sga-2023-23f14.pdfMedicaid Program: Managed Care Payments for Services Not Coordinated Through Recipient Restriction Program Providers (2023-S-18)
To determine whether the Department of Health (DOH) provided adequate oversight to ensure managed care recipients in the Recipient Restriction Program received services from the appropriate providers.
https://www.osc.ny.gov/files/state-agencies/audits/pdf/sga-2025-23s18.pdf