Search
Medicaid Program – Improper Supplemental Maternity Capitation Payments to Managed Care Organizations
… To determine whether Medicaid made improper Supplemental Maternity Capitation Payments to managed care organizations. … monthly premiums, MCOs can receive a one-time Supplemental Maternity Capitation Payment (SMCP) for the prenatal and … or birthing center delivery costs associated with the maternity care of a recipient. However, MCOs are not eligible …
https://www.osc.ny.gov/state-agencies/audits/2021/11/29/medicaid-program-improper-supplemental-maternity-capitation-payments-managed-careAusable Valley Central School District - Medicaid Reimbursements (2018M-189)
… all Medicaid reimbursements to which it was entitled for services provided to eligible special education students. … to ensure Medicaid claims were submitted and reimbursed for all eligible services provided. Claims were not submitted and reimbursed for 1,674 eligible services totaling $58,965 and service …
https://www.osc.ny.gov/local-government/audits/school-district/2019/01/25/ausable-valley-central-school-district-medicaid-reimbursements-2018m-189Medicaid Program – Overpayments for Medicare Part C Claims
… To determine whether Medicaid made improper payments on Medicare Part C claims for recipients covered by Medicare Advantage Plans. The audit covered the period from May 2018 through April 2023. About the Program Under Medicare Part C, private insurance companies administer …
https://www.osc.ny.gov/state-agencies/audits/2024/12/04/medicaid-program-overpayments-medicare-part-c-claimsMoriah Central School District - Medicaid Reimbursements (2019M-64)
… all Medicaid reimbursements to which it was entitled for services provided to eligible special education students. … to ensure Medicaid claims were submitted and reimbursed for all eligible services provided. Claims were not submitted and reimbursed for 517.5 eligible services totaling $21,211 and service …
https://www.osc.ny.gov/local-government/audits/school-district/2019/06/14/moriah-central-school-district-medicaid-reimbursements-2019m-64Whitehall Central School District - Medicaid Reimbursements (2019M-42)
… all Medicaid reimbursements to which it was entitled for services provided to eligible special education students. … to ensure Medicaid claims were submitted and reimbursed for all eligible services provided. Claims were not submitted and reimbursed for 628 eligible services totaling $24,179. Had these …
https://www.osc.ny.gov/local-government/audits/school-district/2019/06/21/whitehall-central-school-district-medicaid-reimbursements-2019m-42Training Resources for State Agencies and Employees
… View training materials and ondemand videos for classes presented by the Office of Operations …
https://www.osc.ny.gov/state-agencies/trainingCost Saving Opportunities on Payments of Medicare Part C Claims (2020-S-65)
To determine whether Medicaid cost savings can be achieved by modifying the reimbursement methodology for Medicare Part C cost-sharing claims in accordance with federal requirements.
https://www.osc.ny.gov/files/state-agencies/audits/pdf/sga-2021-20s65.pdfState Comptroller DiNapoli Releases Audits
… announced today the following audits have been issued. Office for the Aging (OFA): Long-Term Care Ombudsman Program … or complaint level, which may limit its usefulness in decision making. Auditors also found that many residents of … State Health Insurance Program: CVS Health – Accuracy of Drug Rebate Revenue Remitted to the Department of Civil …
https://www.osc.ny.gov/press/releases/2021/01/state-comptroller-dinapoli-releases-auditsCorinth Central School District - Medicaid Reimbursements (2019M-129)
… all Medicaid reimbursements to which it was entitled for services provided to eligible special education students. … to ensure Medicaid claims were submitted and reimbursed for all eligible services provided. Claims were not submitted and reimbursed for 273 eligible services totaling $16,910. Had these …
https://www.osc.ny.gov/local-government/audits/school-district/2019/09/13/corinth-central-school-district-medicaid-reimbursements-2019m-129Medicaid Program – Improper Premium Payments Made on Behalf of Managed Care Members Residing Outside the State
… all 50 states, the District of Columbia, and Puerto Rico to determine if an individual is receiving … million). While all states, the District of Columbia, and Puerto Rico participate in the PARIS match, not all of them …
https://www.osc.ny.gov/state-agencies/audits/2025/09/09/medicaid-program-improper-premium-payments-made-behalf-managed-care-members-residingMedicaid Program – Inappropriate Premium Payments for Recipients No Longer Enrolled in Mainstream Managed Care and Family Health Plus
… improper premiums in the form of checks, we were unable to account for check payments and thus eliminate them from our … the New York City Human Resources Administration (HRA), determine retroactive disenrollment periods and notify … to void inappropriate premium payments. Our testing at HRA found that officials misinterpreted guidelines governing …
https://www.osc.ny.gov/state-agencies/audits/2017/07/11/medicaid-program-inappropriate-premium-payments-recipients-no-longer-enrolled-mainstreamForms for State Agencies and Employees
… Form # Form Name and Resources Format Accounting AC 22‑S Journal … Federal Grant Amendment Information for SFS Fillable PDF AC 3286‑P Federal Grant Pre-Award Information for SFS Fillable PDF AC 3312‑S AR Deposit Form Excel AC 3329‑S Cash Advance …
https://www.osc.ny.gov/state-agencies/formsCost Saving Opportunities on Payments of Medicare Part C Claims (2020-S-65) 180-Day Response
To determine whether Medicaid cost savings can be achieved by modifying the reimbursement methodology for Medicare Part C cost-sharing claims in accordance with federal requirements.
https://www.osc.ny.gov/files/state-agencies/audits/pdf/sga-2021-20s65-response.pdfAudit of the Tuition Reimbursement Account for the Five Fiscal Years Ended March 31, 2018
… an opinion on the fair presentation of the Financial Statements of the Tuition Reimbursement Account for the five … (Regulations). Key Findings In our opinion, the financial statements referred to above present fairly, in all material … an opinion on the fair presentation of the Financial Statements of the Tuition Reimbursement Account for the five …
https://www.osc.ny.gov/state-agencies/audits/2019/09/06/audit-tuition-reimbursement-account-five-fiscal-years-ended-march-31-2018Examination of Outstanding Premiums
… Consider system enhancements to identify policyholders and account balances for each category of receivables. Assess the …
https://www.osc.ny.gov/state-agencies/audits/2016/08/19/examination-outstanding-premiumsImproper Supplemental Maternity Capitation Payments to Managed Care Organizations (Follow-Up)
… eligible to receive the SMCP if it submits encounter claim data as evidence of the delivery and any other inpatient and … that was paid without the required supporting encounter data; $23.4 million that was paid where the encounter data or other evidence indicated the maternity case ended in …
https://www.osc.ny.gov/state-agencies/audits/2023/07/20/improper-supplemental-maternity-capitation-payments-managed-care-organizations-followMedicaid Overpayments for Certain Medicare Part C Claims (Follow-Up)
… of the three recommendations included in our initial audit report, Medicaid Overpayments for Certain … (deductibles, coinsurance, and copayments). We issued our initial audit report on January 16, 2015. The audit objective … the period September 1, 2008 through August 31, 2013. Our initial audit identified 5,571 Medicare Part C claims that …
https://www.osc.ny.gov/state-agencies/audits/2016/12/08/medicaid-overpayments-certain-medicare-part-c-claims-followOverpayments for Medicare Part C Coinsurance Charges (Follow-Up)
… for excessive amounts of coinsurance on 497 claims for clinic services. Because of the excessive claims, Medicaid …
https://www.osc.ny.gov/state-agencies/audits/2013/12/12/overpayments-medicare-part-c-coinsurance-charges-followState Comptroller DiNapoli Releases Audits
… (OTDA) is responsible for reviewing each shelter’s operating budget, working with the local departments of … audit, issued in October 2022, found that, outside of OTDA’s oversight processes for the review and approval of shelter … the approved budget, State laws and regulations, or OTDA’s own policies. OTDA made some progress addressing the issues …
https://www.osc.ny.gov/press/releases/2024/08/state-comptroller-dinapoli-releases-auditsMedicaid Payments for Medicare Part A Beneficiaries (Follow-Up)
… for inpatient care in hospitals, post-hospital nursing home care, hospice, and home health services. If an individual is enrolled in both Medicaid and …
https://www.osc.ny.gov/state-agencies/audits/2014/04/04/medicaid-payments-medicare-part-beneficiaries-follow