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Empire BlueCross BlueShield – Controls Over Payments for Special Items
… and recovery of overpayments made to hospitals for special medical items; and took sufficient steps to … The Empire Plan is the primary health benefits plan for NYSHIP, serving about 1.1 million members. The Empire … with member hospitals include reimbursement rate schedules for the payment of inpatient and outpatient hospital …
https://www.osc.ny.gov/state-agencies/audits/2017/06/22/empire-bluecross-blueshield-controls-over-payments-special-itemsManagement of Indoor Air Quality for Individuals With Asthma
… The audit covered the period from April 2014 to January 2021. About the Program Asthma is a significant public health … the period from October 31, 2016 through January 19, 2021, LHDs visited 31,302 households, consisting of 77,353 …
https://www.osc.ny.gov/state-agencies/audits/2022/08/02/management-indoor-air-quality-individuals-asthmaImproper Medicaid Payments for Recipients in Hospice Care (Follow-Up)
… extent of implementation of the 11 recommendations made in our initial audit report, Improper Medicaid Payments for Recipients in Hospice Care ( 2017-S-76 ). About the Program Hospice is a … However, if a Medicaid recipient is also enrolled in Medicare, Medicare is the primary payer and Medicaid is …
https://www.osc.ny.gov/state-agencies/audits/2020/10/15/improper-medicaid-payments-recipients-hospice-care-followMedicaid Program – Improper Medicaid Payments for Misclassified Patient Discharges
… to reimburse hospitals for inpatient medical care. When a hospital bills Medicaid for an inpatient stay, the hospital reports certain information on its claims, such as … a claim where a patient was transferred to another facility may result in a lower payment than if a patient was …
https://www.osc.ny.gov/state-agencies/audits/2021/08/17/medicaid-program-improper-medicaid-payments-misclassified-patient-dischargesBenefits Advisement Services for Individuals With Disabilities Seeking Employment
… Yorkers with disabilities are more than twice as likely to live in poverty. The New York State Employment First … rate by 5 percent. One way the Report recommended this be achieved was by improving benefits advisement services to … email notification system. Active system customers may not be receiving notifications on important benefits for which …
https://www.osc.ny.gov/state-agencies/audits/2021/07/20/benefits-advisement-services-individuals-disabilities-seeking-employmentUse of Federal Funding for Election Technology and Security
… from the 2018 Help America Vote Act Election Security Grant to enhance the security of the State’s election … systems. In 2018, the EAC made the HAVA Election Security Grant (HAVA Security Grant) available to help states improve and enhance election … from the 2018 Help America Vote Act Election Security Grant to enhance the security of the States election …
https://www.osc.ny.gov/state-agencies/audits/2021/09/17/use-federal-funding-election-technology-and-securityUnitedHealthcare – Reasonable and Customary Reimbursement Rates for Delayed Claims
… whether UnitedHealthcare (United) paid claims using reasonable and customary (R&C) reimbursement rate schedules … To determine whether UnitedHealthcare paid claims using reasonable and customary reimbursement rate schedules that …
https://www.osc.ny.gov/state-agencies/audits/2019/12/12/unitedhealthcare-reasonable-and-customary-reimbursement-rates-delayed-claimsMaximizing Drug Rebates for Health and Recovery Plans (Follow-Up)
… requesting rebates from drug manufacturers. The Affordable Care Act, enacted in 2010, extended prescription drug rebates … medications dispensed to enrollees of Medicaid managed care organizations. In October 2015, adult Medicaid … and Recovery Plans (HARPs). HARPs are a type of managed care program that provides specialized care, including …
https://www.osc.ny.gov/state-agencies/audits/2020/01/17/maximizing-drug-rebates-health-and-recovery-plans-followEmpire BlueCross – Controls Over Payments for Special Items (Follow-Up)
… district employees, and their dependents. The Empire Plan is the primary health benefits plan for NYSHIP. Empire … member hospitals include rate schedules for the payment of inpatient and outpatient hospital services. Hospitals may be entitled to …
https://www.osc.ny.gov/state-agencies/audits/2020/02/25/empire-bluecross-controls-over-payments-special-items-followMedicaid Program – Excessive Payments for Durable Medical Equipment Rentals
… Medicaid managed care organizations inappropriately paid for durable medical equipment beyond allowed rental limits, and whether the Medicaid program could achieve cost savings … Medicaid managed care organizations inappropriately paid for durable medical equipment beyond allowed rental limits …
https://www.osc.ny.gov/state-agencies/audits/2023/04/12/medicaid-program-excessive-payments-durable-medical-equipment-rentalsSelected Aspects of Accommodations for Passengers With Disabilities (Follow-Up)
… City metropolitan area. The Americans with Disabilities Act of 1990 (Act or ADA) was signed into law to provide people with a … in the same day-to-day activities as everyone else. The Act defines disability as a physical or mental impairment …
https://www.osc.ny.gov/state-agencies/audits/2023/05/12/selected-aspects-accommodations-passengers-disabilities-followImproper Managed Care Payments for Misclassified Patient Discharges (Follow-Up)
… has the Department made enhancements to the Medicaid Data Warehouse to allow for a more thorough review of claims …
https://www.osc.ny.gov/state-agencies/audits/2023/12/06/improper-managed-care-payments-misclassified-patient-discharges-followAnnual Assessment of Market Orders for 2015 and 2016
… procedures in place during the audit period to accurately report its assessable expenses related to its administration … The Department had established procedures to accurately report its assessable expenses for the two years ended June … procedures in place during the audit period to accurately report its assessable expenses related to its administration …
https://www.osc.ny.gov/state-agencies/audits/2019/05/16/annual-assessment-market-orders-2015-and-2016Medicaid Overpayments for Inpatient Care Involving Mechanical Ventilation Services
… overpayments were made to hospitals for mechanical ventilation services reported on APR-DRG (All Patient Refined … 1, 2014 through December 31, 2018. Background Mechanical ventilation is the use of a device to inflate and deflate a patient’s lungs. Mechanical ventilation provides the force needed to deliver air to the …
https://www.osc.ny.gov/state-agencies/audits/2019/05/16/medicaid-overpayments-inpatient-care-involving-mechanical-ventilation-servicesMedicaid Program – Medicaid Overpayments for Medicare Advantage Plan Services
… providers’ Medicaid claims for services also covered by Medicare Advantage plans. The audit covered the period from January 1, 2013 to … Background Many Medicaid recipients are also enrolled in Medicare Part C, also known as Medicare Managed Care or … providers Medicaid claims for services also covered by Medicare Advantage plans …
https://www.osc.ny.gov/state-agencies/audits/2018/12/11/medicaid-program-medicaid-overpayments-medicare-advantage-plan-servicesRestrictions on Consecutive Hours of Work for Nurses (Follow-Up)
… Objective To determine the extent of implementation of the five … of Section 167 of the New York State Labor Law – referred to as the Restrictions on Consecutive Hours of Work for … (LPNs) in non-emergency situations. The Law applies to RNs and LPNs who provide direct patient care in hospitals, …
https://www.osc.ny.gov/state-agencies/audits/2019/09/09/restrictions-consecutive-hours-work-nurses-followImplementation of the Dignity for All Students Act (Follow-Up)
… at most schools we visited were not aware of DASA record retention requirements. We also found that certain schools …
https://www.osc.ny.gov/state-agencies/audits/2019/11/21/implementation-dignity-all-students-act-followMedicaid Program – Improper Payments for Certain Third-Party Cost-Sharing Claims
… such as Medicare and group health plans (third-party insurers). Medicaid is considered the payer of last resort … are required to coordinate benefits with third-party insurers prior to billing Medicaid for services. After … adjustments (CARCs), and denials received from other insurers to allow correct calculation of Medicaid …
https://www.osc.ny.gov/state-agencies/audits/2025/11/05/medicaid-program-improper-payments-certain-third-party-cost-sharing-claimsTown of Somerset – Budgeting for Sales Tax (2016M-419)
Town of Somerset Budgeting for Sales Tax 2016M419
https://www.osc.ny.gov/local-government/audits/town/2017/11/22/town-somerset-budgeting-sales-tax-2016m-419Brighter Choice Charter School for Boys - Payroll (2018M-139)
… paid 15 employees who were paid $123,754 over four payroll periods during the audit period. 1 We reviewed the … Brighter Choice Charter School for Boys Payroll 2018M139 …
https://www.osc.ny.gov/local-government/audits/charter-school/2018/10/12/brighter-choice-charter-school-boys-payroll-2018m-139