Search
UnitedHealthcare – Reasonable and Customary Reimbursement Rates for Delayed Claims
To determine whether UnitedHealthcare paid claims using reasonable and customary reimbursement rate schedules that did not correlate
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)
To determine the extent of implementation of the two recommendations made in our initial audit report Maximizing Drug Rebates for Health and Recovery Plans Report 2017S61
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
… whether the Medicaid program could achieve cost savings by implementation of a rental cap on oxygen equipment. The … that can withstand repeated use and have been ordered by a practitioner in the treatment of a specific medical … has no limit on the number of rental payments allowed. By comparison, under Medicare, oxygen equipment rentals are …
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)
To determine the extent of implementation of the seven recommendations included in our initial audit report Selected Aspects of Accommodations for Passengers With Disabilities 2019S41
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)
… Medicaid Program. Many Medicaid recipients receive their medical services through managed care, whereby the Department … from six hospitals, and reviewed the associated patients’ medical records. Our review found: 47 claims were overpaid …
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 (Department) had adequate procedures in place during … to its administration of Article 25 of the Agriculture and Markets Law. Our audit covered the period July 1, 2014 … Program. In addition, Article 25 of the Agriculture and Markets Law authorized market orders and allowed for the …
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
… Hospitals use International Classification of Diseases (ICD) procedure codes on their claims to report mechanical … ventilation services. When hospitals use a specific ICD procedure code to report a patient received 96 … for 4,874 inpatient APR-DRG claims that included an ICD procedure code for 96 consecutive hours or more of …
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 … Background Many Medicaid recipients are also enrolled in Medicare Part C, also known as Medicare Managed Care or Medicare Advantage. Under Medicare …
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)
… consecutive hours of work by Registered Nurses (RNs) and Licensed Practical Nurses (LPNs) in non-emergency … and the Correction Law. The Law, and applicable Department regulations, prevent facilities from requiring nurses to work … declaration of an emergency. Our initial report, issued on April 23, 2018, found the Division lacked policies and …
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)
… Objective To determine the extent of implementation of the three recommendations included in our initial audit report, Implementation of the Dignity for All Students Act (Report 2016-S-28 ). … To determine the extent of implementation of the three recommendations …
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
… made overpayments to providers who reported claims with a PR 45 cost-sharing amount. The audit covered the period from … unpaid portion of the claim balance. Group codes include PR (patient responsibility) and CO (contractual obligation). … claims processing and payment system. Claims with a CARC PR 45 are currently configured to pay in eMedNY, while claims …
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-419Brighter Choice Charter School for Boys - Payroll (2018M-139)
… Determine whether internal controls were in place to ensure that employee compensation was accurate, supported … officials effectively designed and implemented procedures to ensure that compensation payments were accurate, and … We reviewed the gross pay calculations of these employees to determine whether salaries and pay rates were authorized, …
https://www.osc.ny.gov/local-government/audits/charter-school/2018/10/12/brighter-choice-charter-school-boys-payroll-2018m-139DiNapoli: IDA Audits Reveal Need For Improved Project Oversight
… development organization with oversight from the IDA board. However, the board failed to provide adequate … $26,000. The board received an annual report monitoring job creation and retention, but the information was based on … reports from project owners, which is not considered a best practice. Wyoming County IDA IDA officials failed to …
https://www.osc.ny.gov/press/releases/2015/09/dinapoli-ida-audits-reveal-need-improved-project-oversightDiNapoli Calls for Transparency From Companies Regarding Affordability Concerns
… largest credit card issuer, and Capital One Financial Corp., owner of the Discover credit card network, about … in making prior authorization determinations, claims reviews, care management processes, and other decisions. A …
https://www.osc.ny.gov/press/releases/2026/03/dinapoli-calls-transparency-companies-regarding-affordability-concernsDiNapoli: State Needs to Improve Services for Vulnerable Adults
… The State Office of Children and Family Services is not adequately overseeing adult protective service providers responsible for protecting vulnerable adults to ensure they are handling … The State Office of Children and Family Services is not adequately overseeing adult protective service …
https://www.osc.ny.gov/press/releases/2021/11/dinapoli-state-needs-improve-services-vulnerable-adultsDiNapoli Releases Fiscal Stress Scores for Villages and Cities
… State Comptroller Thomas P. DiNapoli today announced that 10 … Stress Scores Data Files FSMS Search Tool Tool Track state and local government spending at Open Book New York . Under State Comptroller DiNapoli’s open data initiative, search … State Comptroller Thomas P DiNapoli today announced that 10 …
https://www.osc.ny.gov/press/releases/2022/04/dinapoli-releases-fiscal-stress-scores-villages-and-citiesDiNapoli Announces State Contract & Payment Actions For March 2014
… million Department of Transportation contract with DeFoe Corp. for bridge rehabilitation on I-87 over Mosholu Parkway … million, Flex Electrical Constructors $852,000 and Gozzer Corp. $461,000. Gaming Commission Approved a $4.9 million … contracts valued at $6 million with the PGA Tournament Corp. to host the 2019 PGA Championship and the 2024 Ryder …
https://www.osc.ny.gov/press/releases/2014/04/dinapoli-announces-state-contract-payment-actions-march-2014DiNapoli Announces State Contract & Payment Actions for July 2014
… Construction Inc. to modernize the flight line area at the army aviation support facility at MacArthur Airport. …
https://www.osc.ny.gov/press/releases/2014/08/dinapoli-announces-state-contract-payment-actions-july-2014