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Improper Managed Care Payments for Certain Medicaid Recipients (Follow-Up)
… needed. Of the initial report’s five recommendations, two were implemented, two were partially implemented, and one was not implemented. …
https://www.osc.ny.gov/state-agencies/audits/2015/01/20/improper-managed-care-payments-certain-medicaid-recipients-followStatus of the Board-Approved Capital Plan for 2005-2011 (Follow-Up)
… Purpose To determine the extent of implementation of the five recommendations included in our initial report, Status of the Board-Approved Capital Plan for 2005-2011 (Report … To determine the extent of implementation of the five recommendations included in our initial report New …
https://www.osc.ny.gov/state-agencies/audits/2013/06/27/status-board-approved-capital-plan-2005-2011-followEmpire BlueCross BlueShield – Controls Over Payments for Special Items
… range of services including, but not limited to, hospital services, office visits, home care, medical … rate schedules for the payment of inpatient and outpatient hospital services. Empire’s hospital contracts also allow … Empire BlueCross BlueShield - Payments Made to Hudson Valley Hospital Center (2009-S-99) New York Health Insurance …
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
To determine if the Department of Health Department effectively identified poor housing conditions for residents with asthma and worked with Local Health Departments LHDs to ensure home visits were prioritized
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)
… Objective To determine the extent of implementation of the 11 recommendations made in our initial audit report, Improper … We issued our initial audit report on December 11, 2018. The audit objective was to determine whether … future Medicaid overpayments. Of the initial report’s 11 audit recommendations, 1 was implemented, 3 were partially …
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
… 1, 2015 to December 31, 2019. About the Program The State’s Medicaid program is administered by the Department of … of $457,973 and reviewed the associated patients’ medical records. Our review found: 15 claims were overpaid $252,107 …
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
… Objective To determine if the Office of Mental Health (OMH) has effectively addressed the findings … benefits advisement in the New York State Employment First Commission report. The audit covers the period March 1, 2015 … with disabilities participate in the work force at a rate of less than half that of people without disabilities, …
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 paid claims using reasonable and customary reimbursement rate schedules that did not correlate
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)
… drugs, to Medicaid recipients age 21 or older with serious mental illness and/or substance use disorders. We issued our initial …
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)
… services according to contracts it negotiates with member hospitals. Empire’s contracts with member hospitals include rate schedules for the payment of inpatient and outpatient hospital services. Hospitals may be entitled to additional 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
… Medicaid managed care organizations inappropriately paid for durable medical equipment beyond allowed rental limits, and whether the Medicaid program could achieve … audit covered the period from July 2016 to December 2021 for non-oxygen-related durable medical equipment rentals and …
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)
… initial audit report, Selected Aspects of Accommodations for Passengers With Disabilities ( 2019-S-41 ). Background … airport (and terminal) operators to be responsible for implementing and maintaining boarding accessibility. … A May 2007 DOJ publication established best practices for state and local government website accessibility. The …
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 services for recipients and reimburse providers. When a hospital bills an MCO for an inpatient stay, the hospital reports certain information on its claims, including … Medicaid recipients who were reported as discharged from a hospital but then admitted to a different hospital within the …
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
… 2014 through June 30, 2016 for the Apple and Sour Cherry Market Orders and the period April 1, 2014 through March 31, … the Program During the audit period, the Department’s Market Order Administration was responsible for the … the Apple Market Order and the New York Apple Association, Inc. (NYAA) contract. The Department did not always enforce …
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
… Hospitals use International Classification of Diseases (ICD) procedure codes on their claims to report mechanical … ventilation services. When hospitals use a specific ICD procedure code to report a patient received 96 … for 4,874 inpatient APR-DRG claims that included an ICD procedure code for 96 consecutive hours or more of …
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
… Part C, private managed care companies administer Medicare benefits and offer different health care plans (referred to … services that are not covered by original Medicare (e.g., dental services). Plans reimburse health care providers for … If Plans deny a claim or pay a different amount than what a provider billed, Plans must communicate the reasons …
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)
… compliance. The Law does not preclude nurses from volunteering to work additional hours and does not apply in … audit report. Of the five prior audit recommendations, one was implemented and four were partially implemented. Key …
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)
… schools to designate a trained Dignity Act Coordinator (DAC). An amendment effective July 1, 2013 defined … than half of the schools we visited did not communicate DAC contact information throughout the school. Further, …
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
… LLC for pharmacy benefit services for the State’s Empire Plan, Excelsior Plan, and Student Health Plan. Paid more than $31.4 million … Exchange ($29.2 million), the Medicaid and Child Health Plus Insurance Program Enrollment Center ($1.8 million) and …
https://www.osc.ny.gov/press/releases/2014/04/dinapoli-announces-state-contract-payment-actions-march-2014