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An Analysis of Reasonable and Customary Out-of-Network Reimbursement Rates for Medical/Surgical Services in the New York State Health Insurance Program
… and customary (R&C) rate. MultiPlan, Inc. is the provider network leased by United to supplement its own network. If the out-of-network provider does not receive the MultiPlan rate, United will reimburse the provider at the R&C rate. The R&C rate is generally based on …
https://www.osc.ny.gov/state-agencies/audits/2020/04/01/analysis-reasonable-and-customary-out-network-reimbursement-rates-medicalsurgical-servicesComptroller DiNapoli Releases Municipal Audits
… transparency and accountability for our local communities is a top priority,” said DiNapoli. “By auditing municipal … Town of Elmira – Financial Condition (Chemung County) The board has not developed adequate plans to improve … for the reconciliation and reporting of cash receipts from trash bag sales to residents used to pay for their refuse …
https://www.osc.ny.gov/press/releases/2016/01/comptroller-dinapoli-releases-municipal-audits-0Central Office – Controls Over Bank Accounts
… York’s (CUNY) Central Office adequately ensured that all bank accounts were authorized and only used for appropriate … and transactions. The audit covers CUNY Central Office bank accounts for the period January 1, 2013 through July 13, … requires the University Controller to ensure that each bank account complies with University policies and …
https://www.osc.ny.gov/state-agencies/audits/2017/11/29/central-office-controls-over-bank-accountsMedicaid Program – Appropriateness of Medicaid Eligibility Determined by the New York State of Health System
… has adequate controls to ensure accurate enrollments in the Medicaid program and to determine whether improper … of the federal Patient Protection and Affordable Care Act in 2010, the State developed the New York State of Health … of the scope limitation on the conclusions presented in our report. Using other Medicaid data sources, we …
https://www.osc.ny.gov/state-agencies/audits/2015/10/28/medicaid-program-appropriateness-medicaid-eligibility-determined-new-york-state-healthQuality of Internal Control Certifications (Follow-Up)
… Purpose In 2012, we conducted a series of audits at 12 State agencies focusing specifically on their 2011-2012 … supporting the answers given. The 12 audits were performed at the following agencies: Department of Agriculture and … needed to the quality of Internal Control Certifications at 10 of the 12 agencies. We found instances where Internal …
https://www.osc.ny.gov/state-agencies/audits/2015/07/07/quality-internal-control-certifications-followUnited Healthcare – Empire Plan Drug Rebate Revenue (Follow-Up)
… of New York: Empire Plan Drug Rebate Revenue ( 2013-S-41 ). Background The New York State Health Insurance … with United HealthCare (United) to administer the Plan’s prescription drug program between January 1, 2008 and … Payments for Fraudulent and Improper Claims Submitted by Davis Ethical Pharmacy (2012-S-10) …
https://www.osc.ny.gov/state-agencies/audits/2015/12/03/united-healthcare-empire-plan-drug-rebate-revenue-followControls Over Cash Advance Accounts
… needs its cash advance accounts and whether the money is properly accounted for and used for appropriate business … totaling over $4,600 for employee payroll advances, which is prohibited by the Comptroller’s requirements established … needs its cash advance accounts and whether the money is properly account …
https://www.osc.ny.gov/state-agencies/audits/2014/12/22/controls-over-cash-advance-accountsPersonal Income Tax Refunds
… tax refunds approved by the Department of Taxation and Finance (Department) for payment were appropriate and … tax refunds approved by the Department of Taxation and Finance Department for paymen …
https://www.osc.ny.gov/state-agencies/audits/2014/04/16/personal-income-tax-refundsCosts to Administer the Insurance Division Operations for the Three Fiscal Years Ended March 31, 2012
… the core functions of regulating all insurance activities in New York, including life, property/casualty and health … and licensing/monitoring agents, brokers and adjusters. In accordance with Section 332 of the Insurance Law, the … United States branches of foreign insurers domiciled in New York State. Section 332 requires the State Comptroller …
https://www.osc.ny.gov/state-agencies/audits/2013/10/09/costs-administer-insurance-division-operations-three-fiscal-years-ended-march-31-2012Medicaid Program – Payments for Death-Related One-Day Inpatient Admissions
… effectively implemented and applied the new APR DRG-based hospital inpatient payment system for Medicaid services when … implemented to provide a more equitable payment method for hospital inpatient services and to better reflect the … For instance, Medicaid paid $153,329 on a claim with hospital charges totaling $9,685 for a patient who died …
https://www.osc.ny.gov/state-agencies/audits/2013/08/15/medicaid-program-payments-death-related-one-day-inpatient-admissionsAccountability and Surplussing of Vehicles (Follow-Up)
… Objective To determine the extent of implementation of the recommendations included in our initial audit report, Accountability and Surplussing of Vehicles ( 2018-S-42 ). Background The New York State … To determine the extent of implementation of the recommendations included in our …
https://www.osc.ny.gov/state-agencies/audits/2021/05/27/accountability-and-surplussing-vehicles-followMedicaid Program – Improper Supplemental Maternity Capitation Payments to Managed Care Organizations
… (MCOs) a monthly premium for each enrolled recipient and, in turn, the MCOs pay for services their members require. In addition to the monthly premiums, MCOs can receive a … not eligible to receive SMCPs for maternity cases that end in termination or a miscarriage, as these are considered …
https://www.osc.ny.gov/state-agencies/audits/2021/11/29/medicaid-program-improper-supplemental-maternity-capitation-payments-managed-careProject Tracking Systems and Economic Assistance Program Evaluations
… mission. Key Findings With few exceptions, such as the film tax credit programs, ESD does not evaluate its economic …
https://www.osc.ny.gov/state-agencies/audits/2021/10/18/project-tracking-systems-and-economic-assistance-program-evaluationsOversight of Residential Domestic Violence Programs (Follow-Up)
… audit report, Oversight of Residential Domestic Violence Programs (Report 2017-S-16 ). About the Program With the … and establishes mainstream funding mechanisms for these programs. As a result of the Act, the Office of Children and … of non-residential and residential domestic violence (DV) programs. OCFS’ Division of Child Welfare and Community …
https://www.osc.ny.gov/state-agencies/audits/2020/02/25/oversight-residential-domestic-violence-programs-followOversight of Selected Fiscal Aspects of Homeless Shelter Services (Follow-Up)
… report, Oversight of Selected Fiscal Aspects of Homeless Shelter Services (Report 2016-N-1 ). About the Program Governed by a “right to shelter” mandate, New York City provides temporary emergency shelter to every eligible person who requests services. DHS, …
https://www.osc.ny.gov/state-agencies/audits/2020/05/06/oversight-selected-fiscal-aspects-homeless-shelter-services-followOversight of Mental Health Education in Schools (Follow-Up)
… Objective To determine the extent of implementation of the two recommendations included in our initial audit report, Oversight of Mental Health Education in Schools (Report 2020-S-63 ). … To determine the extent of implementation of the two recommendations included in our …
https://www.osc.ny.gov/state-agencies/audits/2023/09/27/oversight-mental-health-education-schools-followSelected Wage Investigation Procedures (Follow-Up)
… included in our initial audit report, Selected Wage Investigation Procedures ( 2019-S-46 ). About the … State Labor Laws (Laws), such as those that cover minimum wage and overtime, illegal deductions, day-of-rest and meal … in penalties, wages, and interest as a result of its wage investigations during calendar years 2022, 2021, and …
https://www.osc.ny.gov/state-agencies/audits/2024/02/16/selected-wage-investigation-procedures-followAccess Controls Over Selected Critical Systems
… in New York State. Its responsibilities encompass a wide range of social services programs, including: foster care and … Technology Services. OCFS’ systems contain a broad range of sensitive information that is considered …
https://www.osc.ny.gov/state-agencies/audits/2019/03/21/access-controls-over-selected-critical-systemsProblem Gambling Treatment Program
… Substance Abuse Services (OASAS) has sufficient treatment programs for problem gamblers. Our audit covered the period … approximately 1,600 prevention, treatment, and recovery programs, including, as of 2005, problem gambling treatment. … services through 20 problem gambling-only outpatient programs, six inpatient Addiction Treatment Centers, and the …
https://www.osc.ny.gov/state-agencies/audits/2019/02/05/problem-gambling-treatment-programFinancial Oversight of the Advantage After School Program (Follow-Up)
… of implementation of the two recommendations included in our initial audit report, Financial Oversight of the … age-appropriate activities that integrate what happens in the school day with less formal learning experiences and … active participation among children, youth, and parents in the design and delivery of activities. OCFS awards …
https://www.osc.ny.gov/state-agencies/audits/2019/09/27/financial-oversight-advantage-after-school-program-follow