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Medicaid Program - Medicaid Overpayments for Certain Medicare Part C Claims
… rendered to recipients enrolled in UnitedHealthcare’s Medicare Advantage plan: UnitedHealthcare Dual Complete. The … Part C, the Medicare managed care program also known as Medicare Advantage. Under Medicare Part C, private managed care companies administer Medicare benefits. These Medicare Advantage Plans typically have networks of …
https://www.osc.ny.gov/state-agencies/audits/2015/01/16/medicaid-program-medicaid-overpayments-certain-medicare-part-c-claimsOverpayments for Services Also Covered by Medicare Part B (Follow-Up)
… Part B, which provides supplementary medical insurance for a broad range of outpatient medical services, physicians’ … Medicare is generally the primary payer while Medicaid is a secondary payer. As a secondary payer, Medicaid pays the … which would otherwise be the financial obligation of the patient (such as deductibles and coinsurance). Federally …
https://www.osc.ny.gov/state-agencies/audits/2015/06/26/overpayments-services-also-covered-medicare-part-b-followSubway Service Diversions for Maintenance and Capital Projects (Follow-Up)
… and ended early. As a result, Transit could not justify why diversion costs exceeded budgets, and unproductive time …
https://www.osc.ny.gov/state-agencies/audits/2015/09/16/subway-service-diversions-maintenance-and-capital-projects-followOverpayments for Services Also Covered by Medicare Part B (Follow-Up)
… audit report, Overpayments for Services Also Covered by Medicare Part B (2010-S-50). Background Many of the State's Medicaid recipients are also eligible for Medicare Part B, which provides supplementary medical … supplies. Individuals enrolled in both Medicaid and Medicare are commonly referred to as "dual eligible." …
https://www.osc.ny.gov/state-agencies/audits/2014/03/06/overpayments-services-also-covered-medicare-part-b-followUnnecessary Medicaid Payments for Children at Voluntary Agencies (Follow-Up)
… of the five recommendations made in our audit report, Unnecessary Medicaid Payments for Children at Voluntary Agencies (2010-S-47). Background Our initial audit report, which was issued on September 19, 2012, examined … of the five recommendations made in our audit report Unnecessary Medicaid Payments for Children at …
https://www.osc.ny.gov/state-agencies/audits/2014/10/23/unnecessary-medicaid-payments-children-voluntary-agencies-followImproper Managed Care Payments for Certain Medicaid Recipients (Follow-Up)
… of the five recommendations made in our audit report, Improper Managed Care Payments for Certain Medicaid Recipients (Report 2010-S-66). Background Our initial audit report, which … of the five recommendations made in our audit report Improper Managed Care Payments for Certain Medicaid …
https://www.osc.ny.gov/state-agencies/audits/2015/01/20/improper-managed-care-payments-certain-medicaid-recipients-followStatus of the Board-Approved Capital Plan for 2005-2011 (Follow-Up)
… the five recommendations included in our initial report, Status of the Board-Approved Capital Plan for 2005-2011 … Authority (Authority) in monitoring and reporting on the status of the project items in the Board-Approved Capital … of Interest New York State Thruway Authority: Status of the Board-Approved Capital Plan for 2005-2011 …
https://www.osc.ny.gov/state-agencies/audits/2013/06/27/status-board-approved-capital-plan-2005-2011-followEmpire BlueCross BlueShield – Controls Over Payments for Special Items
… of overpayments made to hospitals for special medical items; and took sufficient steps to minimize the State’s risk … language that limits the reimbursement of special medical items. The audit covered the period January 1, 2013 through … Empire’s hospital contracts also allow certain special items, such as implants, drugs, and blood, to be paid over …
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
… States. It is one of this country’s most common and costly diseases, which often requires emergency care and hospital … and is responsible for a high number of missed school and/or work days. According to the Centers for Disease Control … According to the CDC, people with moderate-to-severe or uncontrolled asthma are more likely to be hospitalized …
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)
… 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 … of implementation of the 11 recommendations made in our initial audit report Improper Medicaid Payments for …
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
… whether the Medicaid program made inappropriate fee-for-service (FFS) payments to hospitals that failed to … their claims. The Department uses the All Patient Refined Diagnosis Related Groups methodology to reimburse hospitals … admission and when the services ended. This information is used to calculate the payment made to the hospital. Hospitals …
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
… the U.S. Census Bureau’s 2018 American Community Survey (ACS). In 2018, there were approximately 1 million working-age … about 75 percent for people without disabilities. Further, ACS data shows that New Yorkers with disabilities are more …
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
… available funding from the 2018 Help America Vote Act Election Security Grant to enhance the security of the State’s election technology and infrastructure. The audit covered the … available funding from the 2018 Help America Vote Act Election Security Grant to enhance the security of the States …
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
… 31, 2018. About the Program The New York State Health Insurance Program (NYSHIP), administered by the Department of … The Empire Plan is the primary health benefits plan for NYSHIP, covering nearly 1.1 million members. Civil … claims is 80 percent of the R&C rate for the service. R&C rates are updated every six months. From January 1, 2017 …
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)
… regularly monitor the activities of its new rebate contractor to help ensure the accuracy of the drug rebate …
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)
… plan for NYSHIP. Empire BlueCross (Empire) administers the hospital portion of the Empire Plan. Empire processes claims for hospital services according to contracts it negotiates with … rate schedules for the payment of inpatient and outpatient hospital services. Hospitals may be entitled to additional …
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
… For example, one MCO established a 10-month rental cap on apnea monitors, yet for one recipient the MCO paid $10,450 on …
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 … established best practices for state and local government website accessibility. The objective of our initial audit, …
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)
… of implementation of the five recommendations included in our initial audit report, Improper Managed Care Payments … (MCOs) a monthly premium for each enrolled recipient and, in turn, the MCOs arrange for the provision of services for … for transfers and discharges are different and may result in lower payments for transfers. The objective of our initial …
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
To determine whether the Department of Agriculture and Markets had adequate procedures in place during the audit period to accurately report its assessable expenses related to its administration of
https://www.osc.ny.gov/state-agencies/audits/2019/05/16/annual-assessment-market-orders-2015-and-2016