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An Analysis of Reasonable and Customary Out-of-Network Reimbursement Rates for Medical/Surgical Services in the New York State Health Insurance Program
… non-participating (out-of-network) providers. United bases payment for most services provided by out-of-network …
https://www.osc.ny.gov/state-agencies/audits/2020/04/01/analysis-reasonable-and-customary-out-network-reimbursement-rates-medicalsurgical-servicesArchived: Legislative Session 2023–2024
… A.10209/S.9701 (McDonald/Stavisky) – Provides that the payment of principal and interest on a qualified education …
https://www.osc.ny.gov/legislation/archived-legislative-session-2023-2024Medicaid Program – Improper Payments for Certain Third-Party Cost-Sharing Claims
… eMedNY, DOH’s automated Medicaid claims processing and payment system. Claims with a CARC PR 45 are currently …
https://www.osc.ny.gov/state-agencies/audits/2025/11/05/medicaid-program-improper-payments-certain-third-party-cost-sharing-claimsAnthem Blue Cross – Effectiveness of the Recovery Process
… where Anthem initially identified that a portion of the payment had been made incorrectly. Key Recommendations Review …
https://www.osc.ny.gov/state-agencies/audits/2026/01/06/anthem-blue-cross-effectiveness-recovery-processImproper Payments Related to the Center of Excellence for Cancer Program
… in payments still require a review to determine which payment (Anthem’s or United’s) should be remitted to Civil …
https://www.osc.ny.gov/state-agencies/audits/2026/01/27/improper-payments-related-center-excellence-cancer-programImproper Payments to a Physical Therapist (Follow-Up)
… Purpose To determine the extent of implementation of the two … included in our initial audit report, Improper Payments to a Physical Therapist ( Report 2013-S-15 ). Background The … To determine the extent of implementation of the two …
https://www.osc.ny.gov/state-agencies/audits/2016/12/08/improper-payments-physical-therapist-followImproper Payments for Controlled Substances That Exceed Allowed Dispensing Limits (Follow-Up)
… report. This included implementing controls to prevent the payment of pharmacy claims for quantities of controlled …
https://www.osc.ny.gov/state-agencies/audits/2016/09/23/improper-payments-controlled-substances-exceed-allowed-dispensing-limits-followOverpayments of Certain Medicare Crossover Claims (Follow-Up)
… Purpose To determine the extent of implementation of the five recommendations made in our audit report, Overpayments of Certain Medicare … Individuals enrolled in both programs are referred to as “dual-eligibles.” Generally, Medicare is the primary … To determine the extent of implementation of the five …
https://www.osc.ny.gov/state-agencies/audits/2014/12/22/overpayments-certain-medicare-crossover-claims-followMedicaid Program – Recovering Managed Care Overpayments for Pharmacy Services on Behalf of Recipients With Third-Party Health Insurance
… Objective To determine whether Medicaid overpayments for pharmacy services on behalf of managed care recipients who … Medicaid services their recipients require, which includes pharmacy services. Many recipients have other third-party … audit period, HMS’ third-party liability recoveries on MCO pharmacy payments totaled about $118 million. Key Findings We …
https://www.osc.ny.gov/state-agencies/audits/2022/07/13/medicaid-program-recovering-managed-care-overpayments-pharmacy-services-behalf-recipientsWestchester County Chapter NYSARC, Inc. – Compliance With the Reimbursable Cost Manual
… in personal service costs, consisting of $1,723 in bonus payment to the Executive Director and $4,693 in duplicated …
https://www.osc.ny.gov/state-agencies/audits/2021/09/29/westchester-county-chapter-nysarc-inc-compliance-reimbursable-cost-manualMedicaid 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-careEmblemHealth Plan, Inc.: Overpayments for Services Requiring Coordination of Benefits
… (secondary payer). This is necessary to prevent duplicate payment of services by the primary and secondary payers. In …
https://www.osc.ny.gov/state-agencies/audits/2024/01/08/emblemhealth-plan-inc-overpayments-services-requiring-coordination-benefitsMedicaid Program – Improper Payments for Drugs Without a Federal Drug Rebate Agreement
… managed care organizations (MCOs) a monthly capitation payment for each Medicaid recipient enrolled in their plans. …
https://www.osc.ny.gov/state-agencies/audits/2024/02/23/medicaid-program-improper-payments-drugs-without-federal-drug-rebate-agreementMedicaid Program – Improper Medicaid Payments for Outpatient Services Billed as Inpatient Claims
… codes, and each service provided could trigger a separate payment. Outpatient services are generally less expensive …
https://www.osc.ny.gov/state-agencies/audits/2023/08/30/medicaid-program-improper-medicaid-payments-outpatient-services-billed-inpatient-claimsMedicaid Program – Improper Medicaid Payments for Childhood Vaccines
… enrolled in Medicaid, the Medicaid program pays the vaccine administration fee. Key Findings Auditors identified … occurred because of control weaknesses in the MCOs’ claims processing systems. Medicaid made improper fee-for-service … for administered VFC Program vaccines. Ensure claims processing controls prevent improper MCO and fee-for-service …
https://www.osc.ny.gov/state-agencies/audits/2018/12/06/medicaid-program-improper-medicaid-payments-childhood-vaccinesState Comptroller DiNapoli Releases State Audits and Examinations
… combined premiums and providing $125.3 million in combined discounts for a hospital and supermarket. NYSIF priced the … be sufficient to cover the ultimate cost of the claims. Discounts were provided to both entities despite the missing …
https://www.osc.ny.gov/press/releases/2017/02/state-comptroller-dinapoli-releases-state-audits-and-examinationsAccounts Payable Advisory No. 1
… PCard, TCard, and NET-Card Payments to JPMorgan Chase Bank, N.A. Filling the Invoice Number Field on the Voucher: In order for JPMorgan Chase … card accounts, agencies must enter their 16 digit billing account number followed by the two-digit billing month and …
https://www.osc.ny.gov/state-agencies/advisories/accounts-payable-advisory/1-complex-entity-jpmorgan-chase-bank-naAccounts Payable Advisory No. 37
… special functions to ensure agencies would not lose this money. Please take this opportunity to reconcile all …
https://www.osc.ny.gov/state-agencies/advisories/accounts-payable-advisory/37-reconciliation-credit-card-transactionsState Comptroller DiNapoli Releases Municipal and School Audits
… reports or ensured claims were properly audited prior to payment. Although the board paid a CPA $6,750 to conduct the …
https://www.osc.ny.gov/press/releases/2025/02/state-comptroller-dinapoli-releases-municipal-and-school-auditsState Comptroller DiNapoli Releases Municipal Audits
… reserve transfers that did not happen totaling $430,000. Ridge Fire District – Board Oversight of Treasurer’s Fiscal …
https://www.osc.ny.gov/press/releases/2022/01/state-comptroller-dinapoli-releases-municipal-audits-0