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United HealthCare – Overpayments for Services Provided by Eastern Orange Ambulatory Surgery Center
… To determine whether Eastern Orange Ambulatory Surgery Center, LLC waived Empire Plan members’ out-of-pocket costs, … submitted to United by Eastern Orange Ambulatory Surgery Center, LLC (Eastern Orange), a non-participating provider … for Services at the Capital Region Ambulatory Surgery Center (2007-S-72) New York State Health Insurance Program: …
https://www.osc.ny.gov/state-agencies/audits/2016/05/05/united-healthcare-overpayments-services-provided-eastern-orange-ambulatory-surgery-centerMedicaid Program – Improper Payments for Controlled Substances That Exceed Allowed Dispensing Limits
… whether the Department of Health paid pharmacy providers for controlled substances in compliance with the New York … risk of drugs ordered in this manner being diverted for inappropriate or unauthorized use. The supply limits that … Medicaid program paid pharmacy providers through the fee-for-service method and the managed care method. Under …
https://www.osc.ny.gov/state-agencies/audits/2015/02/06/medicaid-program-improper-payments-controlled-substances-exceed-allowed-dispensing-limitsSpecial Plan for Suffolk County Park Police Officers (Sections 89-r and 603(n))
… for members about Special Plan for Suffolk County Park Police Officers Sections 89r and 603n …
https://www.osc.ny.gov/retirement/publications/special-plan-suffolk-county-park-police-officers-sections-89-r-and-603nOversight of Hotels and Motels Used for Homeless and Mixed-Use Temporary Residency
… Purpose To determine if the Office of Temporary and Disability Assistance (OTDA) and the Department of Health … (DOH) are adequately ensuring that hotels and motels used for homeless and mixed-use temporary residency are properly … in New York State (2016-D-3) Office of Temporary and Disability Assistance: Oversight of Homeless Shelters …
https://www.osc.ny.gov/state-agencies/audits/2017/06/27/oversight-hotels-and-motels-used-homeless-and-mixed-use-temporary-residencyLifeline Center for Child Development, Inc. – Compliance With the Reimbursable Cost Manual
… claimed on Lifeline’s CFR for the fiscal year ended June 30, 2015, and included certain expenses claimed on Lifeline’s … provide preschool special education services to children with disabilities who are between the ages of three and five … a retiring employee, and $56 for flowers; Lifeline used an allocation methodology that was neither fair nor …
https://www.osc.ny.gov/state-agencies/audits/2017/10/12/lifeline-center-child-development-inc-compliance-reimbursable-cost-manualBrookville Center for Children’s Services, Inc. – Compliance With the Reimbursable Cost Manual
… Purpose To determine whether the costs reported by Brookville Center … (CFRs) were reasonable, necessary, directly related to the special education program, and sufficiently documented pursuant to the State Education Department’s (SED) Reimbursable Cost … Fiscal Reports were reasonable necessary directly related to …
https://www.osc.ny.gov/state-agencies/audits/2017/10/04/brookville-center-childrens-services-inc-compliance-reimbursable-cost-manualPayments for Fraudulent and Improper Claims Submitted by Davis Ethical Pharmacy (Follow-Up)
… of implementation of the three recommendations included in our initial audit report, Payments for Fraudulent and … 10, 2015, William Davis pleaded guilty to Grand Larceny in the Second Degree in Nassau County District Court. He was sentenced on February … the extent of implementation of 3 recommendations included in our initial audit report Payments for Fraudulent and …
https://www.osc.ny.gov/state-agencies/audits/2016/02/18/payments-fraudulent-and-improper-claims-submitted-davis-ethical-pharmacy-followDiNapoli Statement on Greenville Arrest for Alleged Theft of Taxpayer Funded Resources
… New York State Comptroller Thomas P. DiNapoli released the … following an investigation by DiNapoli’s office and the New York State Police. "Mr. Williams allegedly abused his … DiNapoli said. "Thanks to my ongoing partnership with the New York State Police, Mr. Williams' alleged acts have been …
https://www.osc.ny.gov/press/releases/2018/07/dinapoli-statement-greenville-arrest-alleged-theft-taxpayer-funded-resourcesDiNapoli Announces Interim CIO for the New York State Common Retirement Fund
… New York State Comptroller Thomas P. DiNapoli today announced … Titarchuk as Interim Chief Investment Officer of the New York State Common Retirement Fund. The Fund’s current CIO … help grow the Fund and protect the retirement security of New York’s more than one million public employees, retirees …
https://www.osc.ny.gov/press/releases/2018/07/dinapoli-announces-interim-cio-new-york-state-common-retirement-fundMedicaid Program – Improper Fee-for-Service Payments for Pharmacy Services Covered by Managed Care
… for pharmacy services covered by recipients’ managed care plans. The audit covered the period October 1, 2011 … are economically disadvantaged and/or have special health care needs. In general, the Medicaid program pays medical … through either the fee-for-service method or the managed care plan method. Under the feefor- service method, Medicaid …
https://www.osc.ny.gov/state-agencies/audits/2015/01/05/medicaid-program-improper-fee-service-payments-pharmacy-services-covered-managed-careDiNapoli: Contractor Sentenced in Federal Court for Defrauding State of Over $360,000
… Preet Bharara, was sentenced today to a year and one day in prison and ordered to pay a total of $721,112 in restitution and criminal forfeiture. “Joseph Junkovic took … Attorneys and prosecutors statewide to combat corruption in the misuse of public funds.” Junkovic, 49, of the Bronx, …
https://www.osc.ny.gov/press/releases/2014/09/dinapoli-contractor-sentenced-federal-court-defrauding-state-over-360000United HealthCare – Overpayments for Services Provided by Orthopedic Associates of Long Island
… Purpose To determine whether Orthopedic Associates of Long Island, LLP waived Empire Plan members’ out-of-pocket costs, and if so, to quantify the overpayments made by United HealthCare resulting from … To determine whether Orthopedic Associates of Long Island LLP waived Empire Plan members outofpocket …
https://www.osc.ny.gov/state-agencies/audits/2016/05/05/united-healthcare-overpayments-services-provided-orthopedic-associates-long-islandDiNapoli Proposal Would Provide More Accountability for Personal Income Tax Check-Off Funds
… Remembrance and Cemetery Maintenance and Operation, and Teen Health Education. The more than $15 million sitting …
https://www.osc.ny.gov/press/releases/2015/04/dinapoli-proposal-would-provide-more-accountability-personal-income-tax-check-fundsDiNapoli: Village of Candor Mayor Arrested for Allegedly Stealing From the Village
… New York State Comptroller Thomas P. DiNapoli and the New York State Police announced the arrest of Village of Candor Mayor Eric Halstead for stealing from … New York State Comptroller Thomas P DiNapoli and the New York State Police announced the arrest of Village …
https://www.osc.ny.gov/press/releases/2024/07/dinapoli-village-candor-mayor-arrested-allegedly-stealing-villageMedicaid Program – Improper Payments for Ancillary Services Provided During Hospital Inpatient Admissions
… refer to health care services provided in the home, medical offices, clinics, and other freestanding sites. They … to verify recipient eligibility, provider credentials, and medical necessity. Other edits compare claims to each other … for inpatient hospital claims include the costs of most medical care provided during a hospital admission. As such, …
https://www.osc.ny.gov/state-agencies/audits/2014/04/03/medicaid-program-improper-payments-ancillary-services-provided-during-hospital-inpatientState Pension Fund Adds $30 Million for Investments in New York Companies
… The New York State Common Retirement Fund has committed an … Venture Partners to invest in state-based companies, New York State Comptroller Thomas P. DiNapoli announced … to make profitable investments in companies located in New York state. This is the state pension fund’s third …
https://www.osc.ny.gov/press/releases/2015/03/state-pension-fund-adds-30-million-investments-new-york-companiesDiNapoli: Preschool Special Education Provider Received Nearly $6 Million for Ineligible Expenses
… found numerous cases of waste, abuse and in some cases criminal conduct. As a result of these findings and at the … related to these audits have resulted in 10 arrests, seven criminal convictions and the recovery of more than $5 million …
https://www.osc.ny.gov/press/releases/2017/03/dinapoli-preschool-special-education-provider-received-nearly-6-million-ineligible-expensesMedicaid Program – Improper Medicaid Payments for Outpatient Services Billed as Inpatient Claims
… services that were erroneously billed as inpatient claims. The audit covered the period from January 2018 through March … State’s Medicaid program is administered by the Department of Health (Department). The Medicaid program reimburses … inpatient treatments because they are less involved and do not require a patient’s continued presence in a facility. …
https://www.osc.ny.gov/state-agencies/audits/2023/08/30/medicaid-program-improper-medicaid-payments-outpatient-services-billed-inpatient-claimsMedicaid Program – Improper Fee-for-Service Pharmacy Payments for Recipients With Third-Party Health Insurance
… have other third-party health insurance (TPHI) for pharmacy services in addition to Medicaid (e.g., … is considered the payer of last resort and, as such, FFS pharmacy providers are required to coordinate benefits with … period, Gainwell’s third-party liability recoveries on FFS pharmacy payments totaled almost $53 million. Key Findings We …
https://www.osc.ny.gov/state-agencies/audits/2023/05/11/medicaid-program-improper-fee-service-pharmacy-payments-recipients-third-party-healthDiNapoli: Orange County Resident Arrested for Stealing Her Late Mother’s Pension Benefits
… was arrested and charged with grand larceny in the second degree (Class C Felony) for allegedly stealing … was arrested and charged with grand larceny in the second degree Class C Felony for allegedly stealing $5153264 …
https://www.osc.ny.gov/press/releases/2021/06/dinapoli-orange-county-resident-arrested-stealing-her-late-mothers-pension-benefits