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Medicaid Program – Improper Payments for Certain Third-Party Cost-Sharing Claims
… with third-party insurers prior to billing Medicaid for services. After processing a claim from a provider, the … Group codes include PR (patient responsibility) and CO (contractual obligation). CARC 45 occurs when the charge … Medicaid members with Medicare and/or other third-party insurance must accurately reflect payments, adjustments …
https://www.osc.ny.gov/state-agencies/audits/2025/11/05/medicaid-program-improper-payments-certain-third-party-cost-sharing-claimsDiNapoli Announces State Contract & Payment Actions For March 2014
… Approved a $2.2 million Office of Mental Health award to South Shore Association for Independent Living to … million Office of Temporary and Disability Services (OTDA) award to Legal Services NYC for free civil legal services to … Assembly Approved an $80,000 contract with Roemer Wallens Gold & Mineaux LLP for investigations pursuant to the …
https://www.osc.ny.gov/press/releases/2014/04/dinapoli-announces-state-contract-payment-actions-march-2014Medicaid Program - Medicaid Overpayments for Certain Medicare Part C Claims
… providers for services rendered to recipients enrolled in UnitedHealthcare’s Medicare Advantage plan: … Background Many Medicaid recipients are also enrolled in Medicare. Such recipients are commonly referred to as “dual-eligibles.” In 1997, Congress established Medicare Part C, the Medicare …
https://www.osc.ny.gov/state-agencies/audits/2015/01/16/medicaid-program-medicaid-overpayments-certain-medicare-part-c-claimsDiNapoli Releases New Tool for Monitoring NYC 311 Complaints
Nonemergency 311 calls have increased dramatically in New York City since the COVID19 pandemic
https://www.osc.ny.gov/press/releases/2025/05/dinapoli-releases-new-tool-monitoring-nyc-311-complaintsDiNapoli Report Finds Medicaid Costs for Treating Asthma Rising
… the state's overall annual asthma bill topped $1.3 billion for medical costs and lost productivity, according to a … isn't just costly, it can be lethal," DiNapoli said. "For the New Yorkers fighting this chronic disease, a flare-up … emergency room visits. The Medicaid cost to taxpayers for treating asthma has jumped and the prevalence of asthma …
https://www.osc.ny.gov/press/releases/2014/04/dinapoli-report-finds-medicaid-costs-treating-asthma-risingSubway Service Diversions for Maintenance and Capital Projects (Follow-Up)
… Purpose To determine the extent of implementation of the five recommendations included in our initial audit … July 29, 2011, determined that while Transit has a number of policies and procedures for managing and controlling … To determine the extent of implementation of the five recommendations included in our …
https://www.osc.ny.gov/state-agencies/audits/2015/09/16/subway-service-diversions-maintenance-and-capital-projects-followThe Survivor’s Benefit Program for New York State Employees
… employee. You may be eligible even if you are not a member of the New York State Employees’ Retirement System (ERS), the New York State Police … is eligible to receive this benefit if, at the time of your death, you were a full-time employee or officer of … Program provides a minimum death benefit to survivors of eligible New York State employees …
https://www.osc.ny.gov/retirement/publications/survivors-benefit-program-nys-employeesEmpire BlueCross BlueShield – Controls Over Payments for Special Items
… medical items; and took sufficient steps to minimize the State’s risk of excessive payments which result from … January 1, 2013 through December 31, 2016. Background The New York State Health Insurance Program (NYSHIP) provides health …
https://www.osc.ny.gov/state-agencies/audits/2017/06/22/empire-bluecross-blueshield-controls-over-payments-special-itemsOverpayments for Services Also Covered by Medicare Part B (Follow-Up)
… which provides supplementary medical insurance for a broad range of outpatient medical services, physicians’ fees, and … report, which was issued on July 9, 2013, identified $7.3 million in Medicaid overpayments. Most of the overpayments … overpayments for claims that are now more than six years old. Our initial report’s two audit recommendations have been …
https://www.osc.ny.gov/state-agencies/audits/2015/06/26/overpayments-services-also-covered-medicare-part-b-followImproper Managed Care Payments for Certain Medicaid Recipients (Follow-Up)
… extent of implementation of the five recommendations made in our audit report, Improper Managed Care Payments for … years ended June 30, 2010, Medicaid made $15.6 million in improper managed care payments on behalf of 14,899 … who, by State law, were precluded from enrollment in managed care programs. We recommended that the Department …
https://www.osc.ny.gov/state-agencies/audits/2015/01/20/improper-managed-care-payments-certain-medicaid-recipients-followUnnecessary Medicaid Payments for Children at Voluntary Agencies (Follow-Up)
… audit report, Unnecessary Medicaid Payments for Children at Voluntary Agencies (2010-S-47). Background Our initial … the costs of medical care provided to children placed at voluntary agencies. Key Finding Department officials made … of Health: Unnecessary Medicaid Payments for Children at Voluntary Agencies (2010-S-47) …
https://www.osc.ny.gov/state-agencies/audits/2014/10/23/unnecessary-medicaid-payments-children-voluntary-agencies-followOverpayments for Services Also Covered by Medicare Part B (Follow-Up)
… Purpose To determine the extent of implementation of the three recommendations included in our initial audit … Covered by Medicare Part B (2010-S-50). Background Many of the State's Medicaid recipients are also eligible for … To determine the extent of implementation of the three recommendations included in …
https://www.osc.ny.gov/state-agencies/audits/2014/03/06/overpayments-services-also-covered-medicare-part-b-followDiNapoli Announces State Contract & Payment Actions for July 2014
… ensures that costs are reasonable, the playing field is level and taxpayers get the best value for their money. … 50,000 state contracts, visit http://www.openbooknewyork.com/ . The easy-to-use website was created by Comptroller …
https://www.osc.ny.gov/press/releases/2014/08/dinapoli-announces-state-contract-payment-actions-july-2014DiNapoli: Bombay Clerk Sentenced for Pocketing Justice Court Fees
… A North Country court clerk was sentenced yesterday for stealing more than $5,680 from Bombay Justice … A North Country court clerk was sentenced yesterday for stealing more than $5680 from Bombay Justice …
https://www.osc.ny.gov/press/releases/2017/05/dinapoli-bombay-clerk-sentenced-pocketing-justice-court-feesArea #4 – Contracts and Service Level Agreements for IT Services – Information Technology Governance
… to establish expectations, a service level agreement (SLA) should be used to help further expectation clarity and measurement methods. An SLA is different from a traditional written contract in that … are released throughout the year are installed timely, the SLA should indicate exactly what operating system(s) and …
https://www.osc.ny.gov/local-government/publications/it-governance/area-4-contracts-and-service-level-agreements-it-servicesImproper Managed Care Payments for Misclassified Patient Discharges (Follow-Up)
… included in our initial audit report, Improper Managed Care Payments for Misclassified Patient Discharges (Report … recipients receive their medical services through managed care, whereby the Department pays managed care organizations (MCOs) a monthly premium for each enrolled …
https://www.osc.ny.gov/state-agencies/audits/2023/12/06/improper-managed-care-payments-misclassified-patient-discharges-followMedicaid Program – Excessive Payments for Durable Medical Equipment Rentals
… caps). A special category of DME – oxygen equipment – is only available for rental and generally has no limit on the …
https://www.osc.ny.gov/state-agencies/audits/2023/04/12/medicaid-program-excessive-payments-durable-medical-equipment-rentalsEmployment Recovery Is Slow for New Yorkers with Disabilities
… dating back to 2009. 3 In contrast, the ratio declined by only 0.5 percentage points in New York in 2020 and has …
https://www.osc.ny.gov/reports/employment-recovery-slow-new-yorkers-disabilitiesXI.10 Third Party Contracting - Contracting "for" the State – XI. Procurement and Contract Management
… original contract. The state agency is able to justify an amendment to the existing contract as an emergency award that … the third-party contracts let pursuant to the contract amendment are contracts “for” the State and are subject to …
https://www.osc.ny.gov/state-agencies/gfo/chapter-xi/xi10-third-party-contracting-contracting-stateXI.11.H Early Pay Discounts for Procurement Contract Purchases – XI. Procurement and Contract Management
… Contractor generally offers more advantageous special price promotions or special discount pricing to other … the Contract term for a similar quantity, and the maximum price or discount associated with such offer or promotion is … otherwise available under this Contract, such better price or discount shall apply for similar quantity …
https://www.osc.ny.gov/state-agencies/gfo/chapter-xi/xi11h-early-pay-discounts-procurement-contract-purchases