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UnitedHealthcare – Out-of-Network Providers Upcoding Selected Evaluation and Management Services
… of Civil Service (Civil Service) administers NYSHIP. In carrying out its responsibilities, Civil Service contracts … E/M services. Key Findings Improvements are needed in United’s method for monitoring out-of-network providers …
https://www.osc.ny.gov/state-agencies/audits/2018/12/31/unitedhealthcare-out-network-providers-upcoding-selected-evaluation-and-management-servicesJune 2002: GASB Statement 34
… of governmental operations and ultimately result in an increased accountability by the governmental units. This project culminated in June 1999 with the issuance of Statement 34 of the … Government- Wide Reporting Focus on Major Funds Changes in Budgetary Reporting Full accrual accounting including …
https://www.osc.ny.gov/local-government/publications/june-2002-gasb-statement-34United HealthCare – Empire Plan Drug Rebates
… … Determine if United HealthCare Insurance Company of NY credited Department of Civil Service for all rebate …
https://www.osc.ny.gov/state-agencies/audits/2015/12/28/united-healthcare-empire-plan-drug-rebatesUnited HealthCare – Payments for Fraudulent and Improper Claims Submitted by Davis Ethical Pharmacy
… Ethical Pharmacy inappropriately billed United HealthCare for prescription medications under the State's employee … The Empire Plan (Plan) is the primary health benefits plan for NYSHIP and includes prescription drug coverage. The … on the primary contract, the Department reimburses United for all properly adjudicated claims. Davis Ethical Pharmacy …
https://www.osc.ny.gov/state-agencies/audits/2013/08/13/united-healthcare-payments-fraudulent-and-improper-claims-submitted-davis-ethical-pharmacyDiNapoli: Contractor Failed to Turn Over $1.5 Million in Prescription Drug Rebates to NYS
… Read the report , or go to: http://www.osc.state.ny.us/audits/allaudits/093017/16s7.pdf … A company that was …
https://www.osc.ny.gov/press/releases/2016/11/dinapoli-contractor-failed-turn-over-15-million-prescription-drug-rebates-nysNew York State Health Insurance Program – Payments by Empire BlueCross for Hospital Services for Ineligible Members
… limit recoveries to one year or less for claims paid on behalf of members who are retroactively disenrolled (i.e., … language, claims may be recovered for six years. Key Findings The audit identified 3,177 claims totaling $18.2 … time frames, leaving $4.6 million to be recovered. Key Recommendations To Civil Service: Review the $4.6 million …
https://www.osc.ny.gov/state-agencies/audits/2020/08/18/new-york-state-health-insurance-program-payments-empire-bluecross-hospital-servicesAuditory Oral Learning Center – Compliance With the Reimbursable Cost Manual
… direction of, the governing board of the agency. Based in Brooklyn, AOLC provides these SED programs to children in 21 different school districts in four counties in New York City excluding the Bronx. During …
https://www.osc.ny.gov/state-agencies/audits/2019/12/31/auditory-oral-learning-center-compliance-reimbursable-cost-manualEmpire BlueCross BlueShield – Selected Payments for Special Items for the Period January 1, 2012 Through June 30, 2012
… Empire processes Plan claims for hospital services in accordance with agreements they negotiate with member … above the amount Empire should have paid for the items in question. For one hospital, Empire paid $68,382 for three …
https://www.osc.ny.gov/state-agencies/audits/2013/12/13/empire-bluecross-blueshield-selected-payments-special-items-period-january-1-2012-throughCanarsie Childhood Center, Inc. – Compliance With the Reimbursable Cost Manual
… primarily on expenses claimed on CCC’s CFR for the fiscal year ended June 30, 2018 and certain expenses claimed on its … who are 3 and 4 years of age. During the 2017-18 school year, CCC served approximately 90 students in its cost-based …
https://www.osc.ny.gov/state-agencies/audits/2022/02/01/canarsie-childhood-center-inc-compliance-reimbursable-cost-manualE&D Children Center, Inc. – Compliance With the Reimbursable Cost Manual
… to children with disabilities who are between the ages of 3 and 5 years. During the 2014-15 school year, E&D served … students with disabilities. The New York City Department of Education (DOE) refers students to E&D and pays for its … $260,173 in non-mandated fringe benefits expenses (e.g., pension, health insurance) that were not proportionately …
https://www.osc.ny.gov/state-agencies/audits/2021/11/16/ed-children-center-inc-compliance-reimbursable-cost-manualEmpire BlueCross BlueShield – Payments to John T. Mather Memorial Hospital (Follow-Up)
… Purpose To determine if the recommendations made in our initial audit report, Empire BlueCross … issued on April 23, 2012, were implemented. Background The New York State Health Insurance Program (NYSHIP) provides … New York State Health Insurance Program: Empire BlueCross Blue Shield - Payments to John T. Mather Memorial Hospital …
https://www.osc.ny.gov/state-agencies/audits/2013/06/04/empire-bluecross-blueshield-payments-john-t-mather-memorial-hospital-followQueens Centers for Progress – Compliance With the Reimbursable Cost Manual
… Objective To determine whether the costs reported by Queens Centers for Progress (QCP) on its Consolidated Fiscal Reports … … To determine whether the costs reported by Queens Centers for Progress QCP on its Consolidated Fiscal Reports …
https://www.osc.ny.gov/state-agencies/audits/2023/08/10/queens-centers-progress-compliance-reimbursable-cost-manualCaucus 2025: Important Information for New Yorkers
… Our Elderly Population: Select Elder Care Program Audits (April 2024) Food Insecurity Persists Post-Pandemic …
https://www.osc.ny.gov/reports/caucus2025-0Caucus 2025: Important Information for New Yorkers
… Our Elderly Population: Select Elder Care Program Audits (April 2024) Food Insecurity Persists Post-Pandemic …
https://www.osc.ny.gov/reports/caucus2025City of Dunkirk – Budget Review (B24-1-10)
… [read complete report – pdf] Purpose The purpose of our budget review was to provide an independent evaluation … in the general, water, wastewater, refuse and boardwalk funds were ($6,827,480), ($1,163,085), ($247,482), $0 and $0; …
https://www.osc.ny.gov/local-government/audits/city/2024/11/27/city-dunkirk-budget-review-b24-1-10Positive Beginnings, Inc. – Compliance With the Reimbursable Cost Manual
… primarily on expenses claimed on Positive Beginnings’ CFR for the fiscal year ended June 30, 2020 and certain expenses claimed on its CFRs for the 2 fiscal years ended June 30, 2019. About the Program … disabilities who are between the ages of 3 and 5 years. For the purpose of this report, these programs are referred …
https://www.osc.ny.gov/state-agencies/audits/2024/03/13/positive-beginnings-inc-compliance-reimbursable-cost-manualUnitedHealthcare Insurance Company of New York – Overpayments for Physician-Administered Drugs (Follow-Up)
… – Overpayments for Physician-Administered Drugs (Report 2021-S-32 ). About the Program The New York State Health … was to assess the extent of implementation, as of March 18, 2025, of the eight recommendations included in our …
https://www.osc.ny.gov/state-agencies/audits/2025/05/21/unitedhealthcare-insurance-company-new-york-overpayments-physician-administered-drugsOpinion 90-39
… views if, among other things, there have been subsequent court cases or statutory amendments that bear on the issues … on behalf of a fire district) TOWN LAW, §181(1); MUNICIPAL HOME RULE LAW, §10(1)(i),(ii)(a)(9-a): A town may not impose … the Legislature's intent to preempt the area of financing capital improvements to town water districts (see also …
https://www.osc.ny.gov/legal-opinions/opinion-90-39Opinion 91-48
… planning board matters. Section 809 provides, in pertinent part, that every application, petition or request submitted … a plat or official map, license or permit must state the name, residence and the nature and extent of the interest of …
https://www.osc.ny.gov/legal-opinions/opinion-91-48Opinion 90-60
… This opinion represents the views of the Office of the State Comptroller at the time it was rendered. The opinion … purchase equipment, machinery and apparatus, subject to a number of provisions intended as safeguards against potential …
https://www.osc.ny.gov/legal-opinions/opinion-90-60