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Empire 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)
… extent of implementation of the two recommendations made in our initial audit report, Maximizing Drug Rebates for Health and Recovery Plans (Report 2017-S-61 ). About the Program In 1990, Congress created the Medicaid Drug Rebate Program, … extent of implementation of the two recommendations made in our initial audit report Maximizing Drug Rebates for …
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-2016Medicaid Overpayments for Inpatient Care Involving Mechanical Ventilation Services
… whether Medicaid overpayments were made to hospitals for mechanical ventilation services reported on APR-DRG (All Patient Refined Diagnosis Related Groups) inpatient claims. The audit covered … may cause Medicaid’s payment to the hospital to increase. For the period of January 1, 2014 through December 31, 2018, …
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 … in Medicare Part C, also known as Medicare Managed Care or Medicare Advantage. Under Medicare Part C, private managed … and offer different health care plans (referred to as Medicare Advantage plans) tailored to the specific needs of …
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)
… initial audit report Restrictions on Consecutive Hours of Work for Nurses (Report 2017-S-14 ). About the Program The … – referred to as the Restrictions on Consecutive Hours of Work for Nurses Law (Law). Effective July 2009, the Law limits the consecutive hours of work by Registered Nurses (RNs) and Licensed Practical Nurses …
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)
… of the three recommendations included in our initial audit report, Implementation of the Dignity for All Students Act (Report 2016-S-28 ). About the … of the three recommendations included in our initial audit report Implementation of the Dignity for All …
https://www.osc.ny.gov/state-agencies/audits/2019/11/21/implementation-dignity-all-students-act-followBrighter Choice Charter School for Boys - Payroll (2018M-139)
… Objective Determine whether internal controls were in place to ensure that employee compensation was accurate, …
https://www.osc.ny.gov/local-government/audits/charter-school/2018/10/12/brighter-choice-charter-school-boys-payroll-2018m-139Medicaid 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)
… our audit was to review the Town's allocation of sales tax for the period January 1, 2015 through November 18, 2016. … Budgeted appropriations in the general and highway funds for 2016 totaled $2 million. Key Findings Town officials … 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-419