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Medicaid Program – Improper Payments for Recipients No Longer Enrolled in Managed Long Term Care Partial Capitation Plans
… Purpose To determine whether the Medicaid program made inappropriate capitation payments to Managed Long Term Care Partial Capitation plans for …
https://www.osc.ny.gov/state-agencies/audits/2016/03/30/medicaid-program-improper-payments-recipients-no-longer-enrolled-managed-long-term-careAssessment of Costs to Administer the Workers’ Compensation Program for the Fiscal Year Ended March 31, 2014
… Purpose The purpose of this performance audit is to determine whether the Workers’ Compensation Board (Board) … The Board has adequate procedures in place to ensure that it accurately identifies and reports its assessable expenses …
https://www.osc.ny.gov/state-agencies/audits/2016/10/26/assessment-costs-administer-workers-compensation-program-fiscal-year-ended-march-31-2014DiNapoli and Brooklyn D.A. Gonzalez: Public Employee Arrested for Using Co-Workers' Identities to Steal Thousands in Gas
… District Attorney Eric Gonzalez for partnering with my office to bring this individual to justice. We have no …
https://www.osc.ny.gov/press/releases/2018/06/dinapoli-and-brooklyn-da-gonzalez-public-employee-arrested-using-co-workers-identities-stealFar Rockaway Pre-School Provider "Investor" Pleads Guilty in Theft of Education Funds Intended for Special Needs Students
… Thomas P. DiNapoli and Queens District Attorney Richard A. Brown today announced that a self-described investor in … Thomas P. DiNapoli said. "I thank District Attorney Brown for this fourth and final guilty plea in the $12.4 … and his three co-defendants," said District Attorney Brown. "The public funds provided to Island Child Development …
https://www.osc.ny.gov/press/releases/2017/04/far-rockaway-pre-school-provider-investor-pleads-guilty-theft-education-funds-intended-special-needsMedicaid Program – Ambulatory Patient Groups Payments for Duplicate Claims and Services in Excess of Medicaid Service Limits
… methodology in an effort to pay providers more accurately for their services. APG claims are reimbursed based on … million in actual and potential overpayments to providers for services that exceeded Medicaid service limits. For example, Medicaid limits dental exams to two times per …
https://www.osc.ny.gov/state-agencies/audits/2015/06/29/medicaid-program-ambulatory-patient-groups-payments-duplicate-claims-and-services-excessComptroller DiNapoli, Manhattan D.A. Bragg Announce Guilty Plea of Former NYU Director of Finance for Major Fraud
… 57, for orchestrating an approximately $3.5 million 6-year fraud relating to two New York University (“NYU”) … in advance of sentencing. She will be sentenced on April 16, 2024. “Cindy Tappe shamelessly used her high-ranking …
https://www.osc.ny.gov/press/releases/2024/02/comptroller-dinapoli-manhattan-da-bragg-announce-guilty-plea-former-nyu-director-finance-major-fraudDiNapoli: Former Medical Office Manager Arrested for Scheme to Defraud the New York State Health Insurance Plan
… will be held accountable.” Gina Bradshaw, 50, of Maybrook, NY, worked as an office manager for multiple doctors in … to the employee from NYSHIP. The employee must then pay the provider out of pocket either with their own funds or … by filing a complaint online at https://www.osc.state.ny.us/investigations , or by mailing a complaint to: Office …
https://www.osc.ny.gov/press/releases/2023/09/dinapoli-former-medical-office-manager-arrested-scheme-defraud-new-york-state-health-insurance-planDiNapoli: Former Throop Supervisor Pays Full Restitution After Pleading Guilty to Felony for Stealing $11,000 from Town
… Letitia James, and the New York State Police announced today. William Tarby pleaded guilty to grand larceny and … of dollars from the town he was supposed to be serving. Today, we are ensuring that he will be held accountable. I … Letitia James and the New York State Police announced today …
https://www.osc.ny.gov/press/releases/2024/02/dinapoli-former-throop-supervisor-pays-full-restitution-after-pleading-guilty-felony-stealing-11000Selected Payments for Special Items Made to St. Mary's Hospital from January 1, 2011 through March 31, 2011
… Plan. Empire processes Plan claims for hospital services in accordance with agreements they negotiate with member … $9,412 from St. Mary’s for the overpayments we identified in this audit. Develop and implement the controls necessary …
https://www.osc.ny.gov/state-agencies/audits/2013/02/01/selected-payments-special-items-made-st-marys-hospital-january-1-2011-through-march-31-2011Medicaid Program – Recovering Managed Care Overpayments for Pharmacy Services on Behalf of Recipients With Third-Party Health Insurance
… Program The Department of Health (Department) administers New York’s Medicaid program. Many of the State’s Medicaid …
https://www.osc.ny.gov/state-agencies/audits/2022/07/13/medicaid-program-recovering-managed-care-overpayments-pharmacy-services-behalf-recipientsSelected Payments for Special Items Made to St. Peter's Hospital from January 1, 2011 through March 31, 2011
To determine if BlueCross BlueShields Empires payments to St Peters Hospital St Peters for special items were made according to the provisions of the
https://www.osc.ny.gov/state-agencies/audits/2013/02/01/selected-payments-special-items-made-st-peters-hospital-january-1-2011-through-march-31Selected Payments for Special Items Made to Mount Sinai Hospital from January 1, 2011 through March 31, 2011
… (Mount Sinai) for special items were made according to the provisions of the agreement between Empire and Mount Sinai. Background The New York State Health Insurance Program (NYSHIP) provides health insurance … for special items should be related to Mount Sinai's costs to acquire them. Key Findings We reviewed six claim …
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 Albany Medical Center from January 1, 2011 through March 31, 2011
… for special items were made according to the provisions of the agreement between Empire and AMC. Background The New … primary health benefits plan for NYSHIP. The Department of Civil Service contracts with Empire to administer the hospitalization portion of the Plan. Empire processes Plan claims for hospital …
https://www.osc.ny.gov/state-agencies/audits/2013/02/01/selected-payments-special-items-made-albany-medical-center-january-1-2011-through-march-31Identifying, Reporting, and Providing Services for Youth at Risk of Sexual Human Trafficking in New York City
… child sex trafficking. The audit covered the period from January 2017 through January 2022 for ACS and from January 2017 through September 2021 for DYCD. About the Program Children and youth 1 are … (OCFS) issued Administrative Directive 15-OCFS-ADM-16: Requirements to Identify, Document, Report and Provide …
https://www.osc.ny.gov/state-agencies/audits/2022/06/06/identifying-reporting-and-providing-services-youth-risk-sexual-human-trafficking-new-yorkSelected Payments for Special Items Made to Arden Hill Hospital From January 1, 2011 Through March 31, 2011
… (Empire’s) payments to Arden Hill Hospital (Arden Hill) 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-arden-hill-hospital-january-1-2011-through-march-31Medicaid Program – Improper Medicaid Payments for Claims Not in Compliance With Ordering, Prescribing, Referring, and Attending Requirements
… whether the Department of Health (Department) paid for claims in violation of federal and State regulations that … require an appropriate National Provider Identifier (NPI) for ordering, prescribing, referring, and attending (OPRA) … disadvantaged and/or have special health care needs. For the State fiscal year ended March 31, 2020, New York’s …
https://www.osc.ny.gov/state-agencies/audits/2021/08/17/medicaid-program-improper-medicaid-payments-claims-not-compliance-ordering-prescribingDiNapoli: Former Tax Collector Accused of Pocketing $88,000 for Car Loans, Amazon Purchases, Food and Other Expenses
… Junction, N.Y., for allegedly stealing more than $88,000 in tax funds collected for the use of the town of Beekman and … allegedly used taxpayer dollars to fund her own personal online shopping,” Comptroller DiNapoli said. “Taxpayers … County District Attorney’s Office for their hard work in exposing this fraud.” The defendant has been charged with …
https://www.osc.ny.gov/press/releases/2021/03/dinapoli-former-tax-collector-accused-pocketing-88000-car-loans-amazon-purchases-food-and-otherSelected Aspects of Leasing Practices for Real Estate Department, Aviation, World Trade Center, and Leasing of Properties
… Bridge Bus Station, and the World Trade Center. PANYNJ’s real estate portfolio consists of over 12,000 acres of land … specified in leases. During our audit scope, PANYNJ’s Real Estate Department leased seven external spaces for its … have notified the municipality of this sub-lease and paid real property taxes. The other lease was for a garage as part …
https://www.osc.ny.gov/state-agencies/audits/2021/05/04/selected-aspects-leasing-practices-real-estate-department-aviation-world-trade-center-andDiNapoli: 33.55 Percent Annual Investment Return for New York State Pension Fund Is Largest in Its History
… state pension fund rode the market rebound from the depths of the pandemic and enjoyed the largest one-year investment … paid out during the fiscal year. Employer contribution rates are determined by investment results over a multi-year … along with numerous other actuarial assumptions, including wage growth, inflation, age of retirement and mortality. …
https://www.osc.ny.gov/press/releases/2021/05/dinapoli-33-point-55-percent-annual-investment-return-new-york-state-pension-fund-largest-its-historyInappropriate Premium Payments for Recipients No Longer Enrolled in Mainstream Managed Care and Family Health Plus (Follow-Up)
… Objective To determine the extent of implementation of the five … care program for individuals whose income was too high to qualify for Medicaid. This program was eliminated …
https://www.osc.ny.gov/state-agencies/audits/2020/02/25/inappropriate-premium-payments-recipients-no-longer-enrolled-mainstream-managed-care-and