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Medicaid Program – Medicaid Claims Processing Activity April 1, 2013 Through September 30, 2013
… Purpose To determine whether the Department of Health’s eMedNY system … Medicaid requirements, and resulted in correct payments to the providers. The audit covered the period April 1, 2013 … claims submitted by providers for services rendered to Medicaid-eligible recipients, and it generates payments to …
https://www.osc.ny.gov/state-agencies/audits/2015/02/05/medicaid-program-medicaid-claims-processing-activity-april-1-2013-through-september-30-2013Institutes of Applied Human Dynamics – Compliance With the Reimbursable Cost Manual
… Purpose To determine whether the costs reported on the Consolidated … adequately, program related, and allowable pursuant to the State Education Department’s (SED) Reimbursable Cost … special education programs, collectively referred to as SED Programs, to disabled children between the ages of …
https://www.osc.ny.gov/state-agencies/audits/2014/12/31/institutes-applied-human-dynamics-compliance-reimbursable-cost-manualAccounts Receivable Collection and Reporting
… receivable collection and reporting procedures were in compliance with applicable laws and regulations for the … receivable collection and reporting practices are in compliance with applicable laws and regulations. As required, … receivable collection and reporting procedures were in compliance with applicable laws and regulations for the …
https://www.osc.ny.gov/state-agencies/audits/2015/08/05/accounts-receivable-collection-and-reportingFinancial Management Practices
… permit fees for access rights to the Great Sacandaga Lake and assesses fees to power companies for dam usage to …
https://www.osc.ny.gov/state-agencies/audits/2014/11/25/financial-management-practicesOversight of Procurements and Loan Programs
… Purpose To determine whether the Development Authority of the North Country (DANC) provided adequate oversight of its procurements and loan programs in accordance with the Public Authorities Law (Law) … Law to provide infrastructure services and economic development in Jefferson, Lewis, and St. Lawrence counties. …
https://www.osc.ny.gov/state-agencies/audits/2015/08/04/oversight-procurements-and-loan-programsUnited HealthCare – Payments for Fraudulent and Improper Claims Submitted by Davis Ethical Pharmacy (Follow-Up)
… Department of Financial Services. On December 10, 2015, William Davis, former owner Davis Ethical Pharmacy, pleaded … in the Second Degree in Nassau County District Court. William Davis was sentenced on February 9, 2016 and made … we did not test, and formally assess the conduct of William Davis. Key Finding United officials made progress …
https://www.osc.ny.gov/state-agencies/audits/2016/02/18/united-healthcare-payments-fraudulent-and-improper-claims-submitted-davis-ethical-pharmacyNew York State Dental Program – Payments for Scaling and Root Planing Procedures (Follow-Up)
… dental claims on behalf of the State. Emblem Health is the parent company of GHI and HIP Health Plan of New York, … in nature. Instead, they are used when periodontal disease is indicated. The objective of the treatment is to help shrink periodontal pockets, heal gum tissue, and …
https://www.osc.ny.gov/state-agencies/audits/2013/11/12/new-york-state-dental-program-payments-scaling-and-root-planing-procedures-followDairy Inspections
… performed approximately 6,000 inspections at almost 1,400 locations (e.g., plants, farms, bulk tankers) in calendar … of Information Technology Services, to easily and readily store, access, and analyze all inspection information. Other …
https://www.osc.ny.gov/state-agencies/audits/2014/10/06/dairy-inspectionsCancer Service Network, Inc.
… This overbilling included: (i) $73,568 for at least 1,903 hours that he did not work, (ii) $192,892 for 4,732 hours he claims to have worked but could not provide documentation to substantiate he worked those hours, (iii) $45,626 for 2,085 hours for work subcontractors …
https://www.osc.ny.gov/state-agencies/audits/2014/09/24/cancer-service-network-incChild Care Licensing and Inspection
… Purpose To determine if the Office of Children and Family Services’ (Office) child care licensing and … through May 9, 2014. Background The Office's mission is to promote the well-being and safety of the State's children, … To determine if the Office of Children and Family Services …
https://www.osc.ny.gov/state-agencies/audits/2014/08/14/child-care-licensing-and-inspectionHate Crime Reporting
… Justice Services (Division) adequately monitors hate crime reporting and takes steps to ensure complete and … city, and local police agencies (agencies) to report crime data, including hate crimes, to the Division. Crimes … practice, age, disability, or sexual orientation. Hate crime incidents that agencies report to the Division include …
https://www.osc.ny.gov/state-agencies/audits/2014/09/25/hate-crime-reportingBus Driver Licensing
… operations into one organization. RBO maintains a fleet of about 5,600 buses operating out of 28 depots. … transporting an estimated 8,400 passengers on a total of 38 days. Safety and Training Division files did not always …
https://www.osc.ny.gov/state-agencies/audits/2013/06/13/bus-driver-licensingOversight of International Offices
… (ESD) monitors the effectiveness of its international offices and manages payments to foreign representatives to … representatives $2.7 million to manage ten international offices. ESD has recently scaled back its international presence and closed offices in Australia, Brazil, Chile, China, Mexico and …
https://www.osc.ny.gov/state-agencies/audits/2013/06/28/oversight-international-officesSelected Aspects of the Motor Carrier Safety Assistance Program
… to more stringent Department enforcement, including on-site compliance reviews or formal Notices of Violation, … have been repaired, or when submitted, if they are on time. As a result, 39 percent of the certifications for …
https://www.osc.ny.gov/state-agencies/audits/2014/01/22/selected-aspects-motor-carrier-safety-assistance-programMedicaid Program – Medicaid Claims Processing Activity October 1, 2012 Through March 31, 2013
… system processes Medicaid claims submitted by providers for services rendered to Medicaid-eligible recipients, and it generates payments to reimburse the providers for their claims. During the six-month period ended March 31, … payments, including: $6,329,458 in questionable payments for claims that were not subjected to the appropriate edits …
https://www.osc.ny.gov/state-agencies/audits/2014/05/22/medicaid-program-medicaid-claims-processing-activity-october-1-2012-through-march-31-2013Improper Medicaid Payments for Terminated Drugs (Follow-Up)
… ). About the Program The State’s Medicaid program is administered by the Department of Health (Department) and is overseen at the federal level by the Centers for Medicare … in the initial audit report, and significant action is still required to prevent future Medicaid overpayments. …
https://www.osc.ny.gov/state-agencies/audits/2022/09/08/improper-medicaid-payments-terminated-drugs-followNew York State Health Insurance Program – Empire Plan Members With Dual Family Coverage (Follow-Up)
… participating organizations who had dual Family coverage at a total cost to the members and participating …
https://www.osc.ny.gov/state-agencies/audits/2022/09/26/new-york-state-health-insurance-program-empire-plan-members-dual-family-coverage-followMedicaid Program – Claims Processing Activity April 1, 2019 Through September 30, 2019
… Objective To determine whether the Department of Health’s (Department) … Medicaid requirements, and resulted in correct payments to the providers. The audit covered the period April 1, 2019 … To determine whether the Department of Healths Department …
https://www.osc.ny.gov/state-agencies/audits/2020/09/02/medicaid-program-claims-processing-activity-april-1-2019-through-september-30-2019Medicaid Program – Claims Processing Activity October 1, 2019 Through March 31, 2020
… Objective To determine whether the Department of Health’s (Department) eMedNY system reasonably ensured … 227 million claims, resulting in payments to providers of more than $36 billion. The claims are processed and paid … for inpatient claims that were billed at a higher level of care than what was actually provided; $740,920 was paid …
https://www.osc.ny.gov/state-agencies/audits/2020/10/20/medicaid-program-claims-processing-activity-october-1-2019-through-march-31-2020Oversight of Casino Revenues and Regulatory Oversight Reimbursement Collections (Follow-Up)
… revenues: $1.07 billion from VLT casinos, including $917 million as education aid; $183.7 million from commercial …
https://www.osc.ny.gov/state-agencies/audits/2021/05/05/oversight-casino-revenues-and-regulatory-oversight-reimbursement-collections-follow