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Medicaid Program – Managed Care Organizations: Payments to Ineligible Providers

… Purpose To determine whether the Department of Health (Department) … care organizations (MCOs) have adequate processes in place to prevent payments to ineligible providers, and whether improper … To determine whether the Department of Health and managed …

https://www.osc.ny.gov/state-agencies/audits/2018/02/26/medicaid-program-managed-care-organizations-payments-ineligible-providers

Purchasing Practices at the Linden Plaza Mitchell-Lama Housing Development

… 2014, Linden Plaza’s management obtained HPD approval for a 10.5 percent rent increase at Linden Plaza to be phased … system. We judgmentally selected two invoices, one for ten refrigerators and another for eight stoves to account for … due to poor record keeping. While they showed us several refrigerators and stoves in a warehouse, they were unable to …

https://www.osc.ny.gov/state-agencies/audits/2018/09/06/purchasing-practices-linden-plaza-mitchell-lama-housing-development

Train On-Time Performance (Follow-up)

… of implementation of the two recommendations included in our initial report, Train On-Time Performance ( 2014-S-56 ). Background Our prior … 74.0 percent and weekend OTP averaged 81.2 percent. In late March 2015, Subways OTP goal was lowered to 75.0 … of implementation of the two recommendations included in our initial report Train OnTime Performance 2014S56 …

https://www.osc.ny.gov/state-agencies/audits/2017/09/27/train-time-performance-follow

Subway Wait Assessment (Follow-Up)

… performance did not improve during the audit period and that New York City Transit had not developed a full and comprehensive plan to deal with the long-term causes of … disruptions, including matters related to major structural and technology improvements. The goal for meeting the weekday …

https://www.osc.ny.gov/state-agencies/audits/2017/10/06/subway-wait-assessment-follow

Medicaid Program – Overpayments of Ambulatory Patient Group Claims

… overpaid Ambulatory Patient Groups (APG) claims because of deficiencies in the claims processing and payment system. … reimbursed based on a patient's condition and complexity of service. The APG system was adopted by the Department of Health (Department) in an effort to more accurately pay …

https://www.osc.ny.gov/state-agencies/audits/2013/08/20/medicaid-program-overpayments-ambulatory-patient-group-claims

Medicaid Program - Medicaid Overpayments for Certain Medicare Part C Claims

… Part C cost-sharing liabilities (deductibles, coinsurance, and copayments). Key Finding From a review of Medicare Part C … copayments, or deductibles. Ten providers adjusted and re-submitted their claims to eMedNY resulting in Medicaid …

https://www.osc.ny.gov/state-agencies/audits/2015/01/16/medicaid-program-medicaid-overpayments-certain-medicare-part-c-claims

Selected Financial Management and Administrative Practices

… Nassau County. Public Administrators are responsible for administering the estates of individuals who die … or willing to administer the estate. They are responsible for collecting, securing, and liquidating each assumed … any residual value to estate beneficiaries. Any unclaimed funds are remitted to New York State after the …

https://www.osc.ny.gov/state-agencies/audits/2015/04/28/selected-financial-management-and-administrative-practices

Medicaid Overpayments for Non-Emergency Out-of-State Inpatient Services (Follow-Up)

… payments for which the Department had not granted the required prior approvals.  Our initial audit report contained …

https://www.osc.ny.gov/state-agencies/audits/2013/03/11/medicaid-overpayments-non-emergency-out-state-inpatient-services-follow

Medicaid Overpayments for Out-of-State Ambulatory Surgery Services (Follow-Up)

… in our initial audit report, Medicaid Overpayments for Out-of-State Ambulatory Surgery Services (Report … was appropriately paying out-of-state providers for ambulatory surgery services provided to New York State Medicaid recipients. For the period from April 16, 2004 through June 30, 2009, …

https://www.osc.ny.gov/state-agencies/audits/2013/01/10/medicaid-overpayments-out-state-ambulatory-surgery-services-follow

Forensic Audit of Select Payroll and Overtime Practices and Related Transactions (Follow-Up)

… of the six recommendations included in our initial report, Forensic Audit of Select Payroll and Overtime Practices and … Other Related Audit/Report of Interest MTA- Metro-North: Forensic Audit of Payments to On-Board Service Managers … of 6 recommendations included in our intl report Forensic Audit of Select Payroll Overtime Practices Related …

https://www.osc.ny.gov/state-agencies/audits/2016/03/18/forensic-audit-select-payroll-and-overtime-practices-and-related-transactions-follow

Empire BlueCross BlueShield – Selected Payments for Special Items for the Period January 1, 2012 Through June 30, 2012 (Follow-Up)

… extent of implementation of the three recommendations made in our audit report, New York State Health Insurance Program: … processes and pays Plan claims for hospital services in accordance with agreements Empire negotiates with member … Key Finding Empire officials made considerable progress in implementing the recommendations we made in our initial …

https://www.osc.ny.gov/state-agencies/audits/2015/12/28/empire-bluecross-blueshield-selected-payments-special-items-period-january-1-2012-through

Suspicious and Fraudulent Medicaid Payments to Affiliated Brooklyn Dentists (Follow-Up)

… through June 8, 2011, Medicaid paid about $6.9 million for services purportedly performed by the six dentists at the … also found that the dentists routinely certified claims for services that were purportedly provided by another … our findings to the State Attorney General’s Office for further investigation. In August 2012, Lawrence Bruckner …

https://www.osc.ny.gov/state-agencies/audits/2015/12/30/suspicious-and-fraudulent-medicaid-payments-affiliated-brooklyn-dentists-follow

United HealthCare – Payments for Fraudulent and Improper Claims Submitted by Davis Ethical Pharmacy (Follow-Up)

… - Payments for Fraudulent and Improper Claims Submitted by Davis Ethical Pharmacy (Report 2012-S-10). Background Our … Plan (NYSHIP) made improper payments totaling $137,459 to Davis Ethical Pharmacy. Based on information obtained from … indicated on the claims), auditors determined that Davis Ethical likely fabricated nearly all of the improper …

https://www.osc.ny.gov/state-agencies/audits/2016/02/18/united-healthcare-payments-fraudulent-and-improper-claims-submitted-davis-ethical-pharmacy

Access-A-Ride Accident Claims (Follow-Up)

… by traditional carriers decreased and reliance on the black car services and taxis increased. The number of … there was an unquantified liability risk associated with black car services and taxis that was expanding and was not …

https://www.osc.ny.gov/state-agencies/audits/2016/05/13/access-ride-accident-claims-follow

Benefit Eligibility Assessment Process (Follow-Up)

… policies and procedures, and whether the Office of Temporary and Disability Assistance’s (OTDA) Fair Hearing … Other Related Audit/Report of Interest Office of Temporary and Disability Assistance and NYC Human Resources …

https://www.osc.ny.gov/state-agencies/audits/2016/06/16/benefit-eligibility-assessment-process-follow

Compliance With Payment Card Industry Standards

… in the United States, consisting of 64 institutions and about 460,000 enrolled students. SUNY System Administration … Key Findings SUNY schools were generally knowledgeable about PCI compliance and the need to protect credit card data …

https://www.osc.ny.gov/state-agencies/audits/2016/06/08/compliance-payment-card-industry-standards

Administration of Tenant Complaints

… New York State Homes and Community Renewal’s Office of Rent Administration addresses tenant complaints in a timely … housing in New York State. The Division’s Office of Rent Administration (Office), the subject of this audit, is responsible for administering New York State’s rent laws. These laws are designed to provide decent, …

https://www.osc.ny.gov/state-agencies/audits/2014/12/11/administration-tenant-complaints

Outstanding Violations (Follow-Up)

… our initial audit report, Outstanding Violations (Report 2010-N-5 ). Background Our initial report, issued on December … York City Department of Buildings: Outstanding Violations (2010-N-5) …

https://www.osc.ny.gov/state-agencies/audits/2014/10/15/outstanding-violations-follow

Safety of Infrastructure (Follow-Up)

… on September 6, 2012, examined whether the Office of Parks, Recreation, and Historic Preservation (Parks) was maintaining its infrastructure to preserve park … to close individual amenities or even sections of the parks to ensure public safety. We found Parks needed to …

https://www.osc.ny.gov/state-agencies/audits/2015/01/06/safety-infrastructure-follow

State Agency Small-Dollar Purchases (Follow-Up)

… entities that existed in 2008-09 were consolidated or closed by 2011-12, while some new entities had been created. …

https://www.osc.ny.gov/state-agencies/audits/2013/11/21/state-agency-small-dollar-purchases-follow