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Empire BlueCross BlueShield – Controls Over Payments for Special Items
… of special items on the hospitals’ gross charges (i.e., no limit); and 16 did not allow for additional reimbursement …
https://www.osc.ny.gov/state-agencies/audits/2017/06/22/empire-bluecross-blueshield-controls-over-payments-special-itemsManagement of Indoor Air Quality for Individuals With Asthma
… asthma. The COVID-19 pandemic has had significant impacts on those living with chronic diseases such as asthma. … evaluate impacts in reducing the levels of asthma in the State. The Department has not conducted an overall evaluation … assess the impact of the HNP on the asthma burden in the State. Develop an evaluation to determine the overall …
https://www.osc.ny.gov/state-agencies/audits/2022/08/02/management-indoor-air-quality-individuals-asthmaImproper Medicaid Payments for Recipients in Hospice Care (Follow-Up)
… audit report, Improper Medicaid Payments for Recipients in Hospice Care ( 2017-S-76 ). About the Program Hospice is a program that provides care to terminally ill … Generally, when eligible Medicaid recipients elect hospice care, they waive their right to use Medicaid for …
https://www.osc.ny.gov/state-agencies/audits/2020/10/15/improper-medicaid-payments-recipients-hospice-care-followMedicaid Program – Improper Medicaid Payments for Misclassified Patient Discharges
… to reimburse hospitals for inpatient medical care. When a hospital bills Medicaid for an inpatient stay, the hospital … a patient was transferred to another facility may result in a lower payment than if a patient was simply discharged … status codes. Key Recommendations Review the $252,107 in overpayments and recover as appropriate. Review the …
https://www.osc.ny.gov/state-agencies/audits/2021/08/17/medicaid-program-improper-medicaid-payments-misclassified-patient-dischargesBenefits Advisement Services for Individuals With Disabilities Seeking Employment
… was about 33 percent compared to about 75 percent for people without disabilities. Further, ACS data shows that … OMH has not taken steps to assess the effectiveness of its email notification system. Active system customers may not be … may be eligible, as notifications are delivered only via email and less than half of the 40,000 WINR customers were …
https://www.osc.ny.gov/state-agencies/audits/2021/07/20/benefits-advisement-services-individuals-disabilities-seeking-employmentUse of Federal Funding for Election Technology and Security
… available funding from the 2018 Help America Vote Act Election Security Grant to enhance the security of the State’s election technology and infrastructure. The audit covered the … available funding from the 2018 Help America Vote Act Election Security Grant to enhance the security of the States …
https://www.osc.ny.gov/state-agencies/audits/2021/09/17/use-federal-funding-election-technology-and-securityUnitedHealthcare – Reasonable and Customary Reimbursement Rates for Delayed Claims
… To determine whether UnitedHealthcare (United) paid claims using reasonable and customary (R&C) reimbursement … that did not correlate with the date of the service on the claims, and to calculate the corresponding financial impact. … United’s reimbursement for certain out-of-network claims is 80 percent of the R&C rate for the service. R&C …
https://www.osc.ny.gov/state-agencies/audits/2019/12/12/unitedhealthcare-reasonable-and-customary-reimbursement-rates-delayed-claimsMaximizing Drug Rebates for Health and Recovery Plans (Follow-Up)
… in our initial audit report, Maximizing Drug Rebates for Health and Recovery Plans (Report 2017-S-61 ). About the … behavioral health needs began to be enrolled into Health and Recovery Plans (HARPs). HARPs are a type of … in our initial audit report Maximizing Drug Rebates for Health and Recovery Plans Report 2017S61 …
https://www.osc.ny.gov/state-agencies/audits/2020/01/17/maximizing-drug-rebates-health-and-recovery-plans-followEmpire BlueCross – Controls Over Payments for Special Items (Follow-Up)
… of implementation of the two recommendations included in our initial audit report, Controls Over Payments for Special … however, some contracts do not have such limitations. Our initial audit report, issued on June 22, 2017, examined … of implementation of the two recommendations included in our initial audit report Controls Over Payments for Special …
https://www.osc.ny.gov/state-agencies/audits/2020/02/25/empire-bluecross-controls-over-payments-special-items-followMedicaid Program – Excessive Payments for Durable Medical Equipment Rentals
… Objectives To determine whether Medicaid managed care organizations … equipment. The audit covered the period from July 2016 to December 2021 for non-oxygen-related durable medical equipment rentals and September 2018 to December 2021 for oxygen-related durable medical equipment …
https://www.osc.ny.gov/state-agencies/audits/2023/04/12/medicaid-program-excessive-payments-durable-medical-equipment-rentalsSelected Aspects of Accommodations for Passengers With Disabilities (Follow-Up)
… PANYNJ staff. Four of the PATH stations, in Manhattan (9th Street, 14th Street, 23rd Street, and Christopher Street) were not accessible for …
https://www.osc.ny.gov/state-agencies/audits/2023/05/12/selected-aspects-accommodations-passengers-disabilities-followImproper Managed Care Payments for Misclassified Patient Discharges (Follow-Up)
… of implementation of the five recommendations included in our initial audit report, Improper Managed Care Payments for … result in lower payments for transfers. The objective of our initial audit report, issued on August 19, 2022, was to … and reviewed the associated patients’ medical records. Our review found: 47 claims were overpaid $323,531 because …
https://www.osc.ny.gov/state-agencies/audits/2023/12/06/improper-managed-care-payments-misclassified-patient-discharges-followAnnual Assessment of Market Orders for 2015 and 2016
… Purpose To determine whether the Department of Agriculture and … had adequate procedures in place during the audit period to accurately report its assessable expenses related to its … To determine whether the Department of Agriculture and …
https://www.osc.ny.gov/state-agencies/audits/2019/05/16/annual-assessment-market-orders-2015-and-2016Medicaid Overpayments for Inpatient Care Involving Mechanical Ventilation Services
… provides the force needed to deliver air to the lungs in a patient whose ability to breathe is diminished or lost. … ventilation services. Key Finding We identified $975,795 in overpayments on 32 inpatient claims that reported 96 …
https://www.osc.ny.gov/state-agencies/audits/2019/05/16/medicaid-overpayments-inpatient-care-involving-mechanical-ventilation-servicesMedicaid Program – Medicaid Overpayments for Medicare Advantage Plan Services
… claims for services also covered by Medicare Advantage plans. The audit covered the period from January 1, 2013 to … Medicare benefits and offer different health care plans (referred to as Medicare Advantage plans) tailored to the specific needs of Medicare … claims for services also covered by Medicare Advantage plans …
https://www.osc.ny.gov/state-agencies/audits/2018/12/11/medicaid-program-medicaid-overpayments-medicare-advantage-plan-servicesRestrictions on Consecutive Hours of Work for Nurses (Follow-Up)
… initial audit report Restrictions on Consecutive Hours of Work for Nurses (Report 2017-S-14 ). About the Program The … – referred to as the Restrictions on Consecutive Hours of Work for Nurses Law (Law). Effective July 2009, the Law limits the consecutive hours of work by Registered Nurses (RNs) and Licensed Practical Nurses …
https://www.osc.ny.gov/state-agencies/audits/2019/09/09/restrictions-consecutive-hours-work-nurses-followImplementation of the Dignity for All Students Act (Follow-Up)
… orientation, weight) and required schools to designate a trained Dignity Act Coordinator (DAC). An amendment effective …
https://www.osc.ny.gov/state-agencies/audits/2019/11/21/implementation-dignity-all-students-act-followDiNapoli Announces State Contract & Payment Actions For March 2014
… Corp. to host the 2019 PGA Championship and the 2024 Ryder Cup at Bethpage State Park. Superstorm Sandy Approved a $75 … 50,000 state contracts, visit http://www.openbooknewyork.com/ . The easy-to-use website was created by Comptroller …
https://www.osc.ny.gov/press/releases/2014/04/dinapoli-announces-state-contract-payment-actions-march-2014DiNapoli Announces State Contract & Payment Actions for July 2014
… - Hurricanes Irene and Lee Hazard Mitigation $17.8 million in grants to 16 municipalities, including the town of Conklin … $894,000 contract with Swank Motion Pictures Inc. for a public performance license to show motion pictures at … spending and nearly 50,000 state contracts, visit http://www.openbooknewyork.com/ . The easy-to-use website was …
https://www.osc.ny.gov/press/releases/2014/08/dinapoli-announces-state-contract-payment-actions-july-2014DiNapoli Announces State Contract & Payment Actions for November 2014
… nearly 1.2 million payments worth nearly $8.9 billion in November. His office also rejected 166 contracts and … Grants to seven recipients including Yonkers Partners in Education, New York City Outward Bound Center and Harlem … County. Division of Criminal Justice Services $5.2 million in grants to crime labs and crime analysis centers statewide. …
https://www.osc.ny.gov/press/releases/2014/12/dinapoli-announces-state-contract-payment-actions-november-2014